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  #1  
Old 09-06-2011
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Question crazy renal path!!!

a 70 yrs old man comes in emergency with 9 day history of decreased urine output and malaise.pastmedical history positive for arthritis for which he took ibupropen and recently sinusitis for which he took amox .has been taking amox for 3 days with no rash or other ill effects.his exam is normal,afebrile,bp is 158/84,pulse 98.lab shows bun of 54,creatinine of 3.5,pot of 6 .liver function test are normal.urinalysis shows protinuria 2+,wbc with casts 11-50,rbc 6-10.urine osmolility 250.what isthe diagnosis
1:atn
2:ain
3post renal failure
4prerenal failure
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  #2  
Old 09-06-2011
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please answer with explanation..thnks
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Old 09-06-2011
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i think,the answer is a) acute tubular necrosis....why i'd like to go with 'a' bcz first of all by looking at bun n c ratio...it's clear that cause is intrarenal...then low osmolarity n presence of rbcs make think about acute tubular necrosis.
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Old 09-06-2011
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I think this is a case of analgesic nephropathy that lead to AIN with wbc casts in urine
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Old 09-06-2011
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Quote:
Originally Posted by samstar View Post
a 70 yrs old man comes in emergency with 9 day history of decreased urine output and malaise.pastmedical history positive for arthritis for which he took ibupropen and recently sinusitis for which he took amox .has been taking amox for 3 days with no rash or other ill effects.his exam is normal,afebrile,bp is 158/84,pulse 98.lab shows bun of 54,creatinine of 3.5,pot of 6 .liver function test are normal.urinalysis shows protinuria 2+,wbc with casts 11-50,rbc 6-10.urine osmolility 250.what isthe diagnosis
1:atn
2:ain
3post renal failure
4prerenal failure
why not ain?....wbc casts...eosinophils?
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Old 09-06-2011
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Originally Posted by add1 View Post
I agree. The answer is acute tubular necrosis. Patients with acute interstitial nephritis usually have fever, rash and eosinophilia.
The triad: low-grade fever, skin rash, and arthralgias is present in only 5 percent of cases of AIN overall..eosinophilia is rare!...eosinophils in urine is more common
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  #7  
Old 09-06-2011
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Question which one??

why ain??
the pt has a history of taking amox and ibuprofen,pot is elevated and urine osmolalityis low.along with positive findings on urinalysis.these are also in favour of atn...theere is no history of fever,rashes, or eosinophilia
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Old 09-06-2011
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So what's the answer?
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  #9  
Old 09-06-2011
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Wink acute interstitial nephritis is the right answer

the answer given is ain....though the explanation did not point our clearly why
but here iswhy i think it was answered as ain...coz even though nsaids can give atn ...ibuprofen accordingto mtb-ck gives more commonly allergic (acute)interstitial nephritis.....also in ain the bun :cr ratio is 20:1..if we see the values in the question we see that the bun is nearly 20 times higher than the creatinine...wher as in atn the bun:cr ratio is less than 20:1...
but like i said..it is a xcrazy renal path question
any one got an easier way to differentiate between ain and atn..pls help
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Quote:
Originally Posted by samstar View Post
why ain??
the pt has a history of taking amox and ibuprofen,pot is elevated and urine osmolalityis low.along with positive findings on urinalysis.these are also in favour of atn...theere is no history of fever,rashes, or eosinophilia
protinuria 2+ + wbc with casts 11-50 => more like AIN than ATN...
and the triad: low-grade fever, skin rash, and arthralgias is present in only 5 percent of cases of AIN

Granular casts = ATN
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  #11  
Old 09-06-2011
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its AIN

wbc cast on urinalysis..eosinophil can be seen with wright stain
NSAIDS are among the few which does not give rash
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Old 09-06-2011
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Quote:
Originally Posted by samstar View Post
a 70 yrs old man comes in emergency with 9 day history of decreased urine output and malaise.pastmedical history positive for arthritis for which he took ibupropen and recently sinusitis for which he took amox .has been taking amox for 3 days with no rash or other ill effects.his exam is normal,afebrile,bp is 158/84,pulse 98.lab shows bun of 54,creatinine of 3.5,pot of 6 .liver function test are normal.urinalysis shows protinuria 2+,wbc with casts 11-50,rbc 6-10.urine osmolility 250.what isthe diagnosis
1:atn
2:ain
3post renal failure
4prerenal failure
LOW osmolarity and bun:cr rule out 3 and 4.

AIN requires rash and esinophiluria and ATN requires muddy brown granular cast in order to confirm diagnosis.

so in between 1 and 2 i think its 2 since patient is taking ibuprofen since long and amox since 3 days so i think its allergic acute interstitial nephritis.
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