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Drug-induced acute interstitial nephritis — SCE Acute Medicine MCQ

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HardAcute Renal and Metabolic EmergenciesDrug-induced acute interstitial nephritisSCE Acute Medicine

An 82-year-old woman develops AKI two weeks after starting omeprazole and flucloxacillin. She has rash, eosinophilia and sterile pyuria. Both drugs are stopped, but creatinine continues rising for five days and the diagnosis remains uncertain. What is the best next step?

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Correct answer: D — Arrange renal biopsy to guide a decision about corticosteroid treatment

Explanation lettering: E = shown as A · A = shown as B · B = shown as C · C = shown as D · D = shown as E

C is correct. Immediate withdrawal of plausible culprit drugs is essential. Persistent deterioration and diagnostic uncertainty justify nephrology review and kidney biopsy, the diagnostic standard, particularly before exposing an older patient to corticosteroids. Fever, rash, eosinophilia and sterile pyuria are suggestive but neither they nor urine eosinophils reliably confirm or exclude acute interstitial nephritis. Early steroid treatment may help selected biopsy-supported drug-induced disease, but evidence is observational. Rechallenge, cyclophosphamide and renal angiography are not justified by this presentation.

Reference: https://doi.org/10.1016/j.ekir.2025.03.050