The Case of the Missing Casts
A 50 y/o woman presents with symptoms of fatigue and malaise for 1-2 weeks. Medications include ACE, HCTZ, and a multivitamin daily. She had a UTI 6 weeks ago that did not improve after a 5 day course…
BWH Path Conference – AIN… or is it
Nephrology was consulted by the general medicine service for AKI in an elderly man with endocarditis. He had MSSA bacteremia for which he was being treated with oxacillin and rifampin. There was no report of rash or recent…
Proton Pump Inhibitors: Indigestion for nephrologists!
Proton pump inhibitors (PPIs) are one of the most commonly prescribed medications, mostly because of their efficacy and their favorable safety profile. However, it has been estimated that between 25% and 70% of these prescriptions do not have…
An atypical form of renal failure: granulomatous interstitial nephritis
A 42-year-old man developed AKI during his recent hospitalization due to presumed sepsis. He was started on vancomycin and levofloxacin as empirical therapy. When renal was consulted 7 days after admission, creatinine level had peaked at 4.39 mg/dl…
The end of the road for urinary eosinophils?
Nate wrote a couple of posts in the past about the use (and misuse) of urinary eosinophils for the diagnosis of acute interstitial nephritis (AIN). Since the original report describing the use of this test in the NEJM…
Kidney Biopsy Case: AKI
A 54 year old man was referred to the Nephrology service due to AKI after presenting with lethargy and severe thirst. He had a long history of pulmonary and hepatic sarcoidosis which had been quiescent for some time….
Lead Nephrotoxicity
I saw a patient in the clinic who was referred for evaluation by his PCP with CKD, a bland urine sediment and a history of hyperuricemia and gout. He had no history of diabetes or hypertension and had…
Warfarin-induced AKI
We have recently posted about problems using warfarin in renal patients. On a similar note, I was recently involved in the care of a 58-year-old African-American patient who presented with oliguric AKI and a supratherapeutic INR level of…
Differential Diagnosis of Granulomatous Kidney Disease
Although it’s not common (somewhere between 0.5 – 0.9% of all native kidney biopsies according to published case series), one of the fellows produced an interesting case of granulomatous interstitial nephritis in Renal Grand Rounds today. The case,…
Steroids for AIN? Poll Results
Very interesting results from last week’s poll, in which the question asked was essentially, “Do you believe that steroids are effective in the treatment of AIN?” The vote was generally split 50-50; that is, about half of individuals…