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Acute interstitial nephritis — ABIM Board MCQ

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ModerateNephrologyAcute interstitial nephritisABIM Board

A 57-year-old develops fever, rash, eosinophilia and rising creatinine ten days after starting omeprazole and amoxicillin. Urine shows sterile pyuria and white-cell casts, and ultrasound shows no obstruction. What is the most likely diagnosis?

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Correct answer: E — Drug-induced acute interstitial nephritis

The best answer is “Drug-induced acute interstitial nephritis”. The timing after new drugs plus systemic hypersensitivity features, sterile pyuria and white-cell casts strongly suggest acute interstitial nephritis. Ischemic tubular injury lacks this allergic pattern, ultrasound argues against obstruction, renal-artery thrombosis presents differently and IgA nephropathy causes glomerular hematuria rather than pyuria.

Reference: KDIGO 2024 Clinical Practice Guideline for Chronic Kidney Disease: https://kdigo.org/wp-content/uploads/2024/03/KDIGO-2024-CKD-Guideline.pdf