Pathology - Acute Tubulointerstitial Nephritis brought on by Drugs
Pathophysiology This patient has acute tubulointerstitial nephritis (ATIN) brought on by drugs. Echogenic kidneys of normal size found on ultrasonography are consistent with parenchymal inflammation, as is the presence of white cell casts and eosinophiluria, which are markers of inflammation. Urinary glucose squandering in the presence of normal serum glucose and the absence of hematuria or proteinuria in this instance indicate tubular illness rather than glomerulopathy. Notably, there is no temperature and a negative urine culture, indicating that renal inflammation is not being caused by a urinary tract infection. ATIN is frequently brought on by an infection or a medication allergy. Antibiotics, NSAIDs, and more lately PPIs—this patient is taking both amoxicillin and a PPI, which are both linked to ATIN—are among the medications that are frequently to blame. A conclusive test would be a renal biopsy, which would typically reveal inflammatory cells infiltrating the renal parenchyma while sparing the glomeruli. Drug withdrawal is the first line of treatment, followed by supportive management and observation. If the first treatment doesn't work, the following measures are a renal biopsy and steroid therapy.
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