Tubulointerstitial Disease — Viva Defence

Opening statement (SASPOP, delivered aloud)

"Mrs Marsh is a 76-year-old woman with biopsy-proven acute interstitial nephritis, almost certainly induced by ten months of omeprazole, presenting as a silent creatinine rise without any allergic features — the typical modern phenotype of drug-induced AIN ^[5]. Her problems are: significant AKI with partial early improvement since drug withdrawal; polypharmacy in an older adult, where deprescribing is both treatment and prevention; a decision about corticosteroids on incomplete evidence; and the need for honest counselling about slow and possibly incomplete renal recovery. My priorities are to consolidate drug withdrawal, finish the steroid decision with her, protect her from re-exposure, and arrange structured renal follow-up." ^{[1] [2]}