Nephrology: acute interstitial nephritis: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Nephrology: acute interstitial nephritis

Sample item

A 45-year-old woman taking omeprazole for 3 weeks develops fever, a rash and a rise in creatinine from 0.9 to 2.6 mg/dL. Urine microscopy shows white cells and white cell casts without red cells, and blood eosinophils are raised. What is the most appropriate management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Stop omeprazole and consider corticosteroids if no early recovery

Drug-induced acute interstitial nephritis is an immune hypersensitivity reaction, commonly to proton pump inhibitors, beta-lactams and NSAIDs. Fever, rash, eosinophilia and sterile pyuria with white cell casts are suggestive, though the triad is often incomplete. The offending drug must be stopped, and steroids are given when function does not improve promptly.

Option by option

  • A. Start an ACE inhibitor for renoprotection

    An ACE inhibitor would reduce GFR further in acute kidney injury and does not treat the cause.

  • B. Continue omeprazole and give intravenous fluids alone

    Continuing the culprit allows ongoing interstitial injury and irreversible fibrosis.

  • C. Stop omeprazole and consider corticosteroids if no early recovery (correct)

    Correct. Withdrawal of the culprit drug is the key step, and steroids speed recovery in selected cases.

  • D. Start haemodialysis immediately

    Dialysis is needed only for refractory hyperkalaemia, acidosis, overload or uraemia, and none is described.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is C, Stop omeprazole and consider corticosteroids if no early recovery. Drug-induced acute interstitial nephritis is an immune hypersensitivity reaction, commonly to proton pump inhibitors, beta-lactams and NSAIDs.

Why is "Start an ACE inhibitor for renoprotection" not the answer?

An ACE inhibitor would reduce GFR further in acute kidney injury and does not treat the cause.

Why is "Continue omeprazole and give intravenous fluids alone" not the answer?

Continuing the culprit allows ongoing interstitial injury and irreversible fibrosis.

Why is "Start haemodialysis immediately" not the answer?

Dialysis is needed only for refractory hyperkalaemia, acidosis, overload or uraemia, and none is described.

What concept does this question test?

It tests Nephrology: acute interstitial nephritis in General Medicine. Fever, rash, eosinophilia and sterile pyuria with white cell casts are suggestive, though the triad is often incomplete. The offending drug must be stopped, and steroids are given when function does not improve promptly.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Nephrology: acute interstitial nephritis?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.