A 65-Year-Old Man Comes to the Office with a 2-Day

question 442

Multiple Choice

A 65-year-old man comes to the office with a 2-day history of skin rash and low-grade fever.  He has had no cough, shortness of breath, chest pain, vomiting, dysuria, or urinary frequency.  The patient was recently diagnosed with acute gouty arthritis and has been taking indomethacin for the past 10 days.  Temperature is 38.1 C (100.6 F) , blood pressure is 130/90 mm Hg, and pulse is 86/min.  Examination shows a diffuse, maculopapular skin rash.  Mucosal surfaces are moist without any lesions.  Cardiopulmonary examination shows no abnormities.  There is no costovertebral angle tenderness.  Serum creatinine is 2.3 mg/dL (baseline 1.1 mg/dL, 2 weeks ago) .  Urinalysis shows numerous white blood cells/hpf.  Which of the following is the most likely cause of this patient's acute renal dysfunction?

• A)Interstitial nephritis
• B)Pyelonephritis
• C)Renal tubular necrosis
• D)Stevens-Johnson syndrome
• E)Uric acid nephropathy

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