azotemia - okt3

[ArchivalUser]

A 72-year-old woman with rheumatic heart disease is being treated with ampicillin and gentamicin for enterococcal endocarditis. One week into the course she develops a morbilliform skin rash and fever.
Laboratory evaluation is remarkable for a doubling of serum creatinine and blood urea nitrogen from their baseline values.
Urinalysis dipstick is positive for blood, protein, and white cells. Ultrasonography reveals bilaterally enlarged kidneys. Based on the available data, the most likely cause of the patient™s azotemia is

A) tubular necrosis caused by aminoglycoside

B) membranous nephropathy resulting from endocarditis

C) enterococcal pyelonephritis

D) cystitis

E) hypersensitivity reaction to ampicillin

[ArchivalUser]

A.

[ArchivalUser]

E) hypersensitivity reaction to ampicillin
It is drug hypersensitive nephropathy

[ArchivalUser]

The answer is E. A number of drugs may elicit an acute interstitial nephritis.

The classic offender is methicillin, although ampicillin, penicillin, cephalothin, thiazides,

furosemide, and nonsteroidal anti-inflammatory drugs also have been associated with this

problem. Hematuria, fever, and skin rash may occur within 1 to 2 weeks of exposure to the

drug. Urinalysis reveals protein, pyuria, and eosinophiluria. Ultrasonography discloses

enlarged kidneys. A biopsy (usually not necessary, since withdrawal of the offending drug

leads to complete resolution) will reveal normal glomeruli but infiltration of the interstitium

with polymorphonuclear leukocytes, lymphocytes, plasma cells, and eosinophils.

[ArchivalUser]

E.