Renal Case: 35-year-old Woman with Increased Serum Creatinine

by Amy Sussman, MD

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    00:01 Let's move on to another case.

    00:03 We have a 35-year-old woman with an increase in serum creatinine from 0.7 to 3.2 mg/dL.

    00:10 She's currently in the ICU receiving nafcillin which is a penicillin by continuous infusion for Staph. aureus endocarditis.

    00:18 On physical exam, she's febrile and she has a very interesting erythematous, maculopapular rash over her thorax and extremities.

    00:28 When we look at her laboratory data, we see that her serum creatinine is now 3.2 mg/dL, you can see that that's elevated.

    00:35 And her complete blood count has an increased number of eosinophils on the differential.

    00:40 Her urine analysis shows white blood cells and white blood cell casts but the urine culture is negative.

    00:48 So the question is, what type of acute kidney injury does this woman have? Let's go through our case and see if we can answer that question.

    00:55 So looking at our history, it's very important to notice that temporal correlation with the administration of nafcillin and the rise in serum creatinine.

    01:05 So essentially, she gets nafcillin, couple of days later we have an increase in serum creatinine.

    01:10 Look at her physical exam, too.

    01:12 On physical exam, she has an erythematous, maculopapular rash which really is also giving us a clue to the diagnosis.

    01:20 Moving on then to our laboratory data, we can see that she has an eosinophilia and that is really suggestive of an allergic or hypersensitivity process.

    01:31 So we combine that with her AKI and her physical exam, that really suggest allergic interstitial nephritis.

    01:39 And the pyuria that she has - so that's the white cells at her urine and that white blood cell cast in the absence of a positive urine culture, highly suggestive of an interstitial nephritis.

    01:51 So, the answer is of course is acute allergic interstitial nephritis.

    About the Lecture

    The lecture Renal Case: 35-year-old Woman with Increased Serum Creatinine by Amy Sussman, MD is from the course Acute Kidney Injury (AKI).

    Included Quiz Questions

    1. White blood cell casts
    2. Red blood cell casts
    3. Cellular debris and muddy brown casts
    4. No cellular debris or casts

    Author of lecture Renal Case: 35-year-old Woman with Increased Serum Creatinine

     Amy Sussman, MD

    Amy Sussman, MD

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