Phys Written Answers · renal
Tubulointerstitial Disease — Written Clinical Reasoning
DCE long-case preparation: structured written reasoning for acute interstitial nephritis — a PPI-induced creatinine drift with deprescribing and steroid reasoning, and checkpoint-inhibitor AKI with rechallenge reasoning.
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SAQ — Interstitial nephritis: drug-induced and checkpoint-inhibitor (20 marks, 30 minutes)
Prompt: Answer both parts, addressing the diagnostic reasoning, immediate management with the steroid decision, and follow-up. Justify each decision with reference to evidence. [1]
Case vignette Part A: A 74-year-old man with polypharmacy presents with a subacute creatinine rise over weeks, sterile pyuria and modest proteinuria, normal-sized kidneys, no rash, fever or eosinophilia, four months after starting omeprazole. [1]
Case vignette Part B: A 62-year-old woman nine cycles into pembrolizumab for melanoma presents with AKI and sterile pyuria. [1]
References6ShowHide
- [1]Praga M, González E. Acute interstitial nephritis Kidney Int, 2010.PMID 20336051
- [2]González E, Gutiérrez E, Galeano C, et al. Early steroid treatment improves the recovery of renal function in patients with drug-induced acute interstitial nephritis Kidney Int, 2008.PMID 18185501
- [3]Muriithi AK, Leung N, Valeri AM, et al. Biopsy-proven acute interstitial nephritis, 1993-2011: a case series Am J Kidney Dis, 2014.PMID 24927897
- [4]Cortazar FB, Kibbelaar ZA, Glezerman IG, et al. Clinical Features and Outcomes of Immune Checkpoint Inhibitor-Associated AKI: A Multicenter Study J Am Soc Nephrol, 2020.PMID 31896554
- [5]Blank ML, Parkin L, Paul C, Herbison P. A nationwide nested case-control study indicates an increased risk of acute interstitial nephritis with proton pump inhibitor use Kidney Int, 2014.PMID 24646856
- [6]Prendecki M, Tanna A, Salama AD, et al. Long-term outcome in biopsy-proven acute interstitial nephritis treated with steroids Clin Kidney J, 2017.PMID 28396740