A 42-year-old woman presents with fever (38.9°C), diffuse maculopapular rash, and bilateral flank pain 5 days after starting trimethoprim-sulfamethoxazole for a skin infection. Vital signs show HR 102/min, BP 138/88 mmHg, RR 18/min. Serum creatinine is 2.8 mg/dL (baseline 0.9), and urinalysis reveals pyuria, white blood cell casts, and eosinophiluria. Notably, no proteinuria or hematuria is present. Which of the following is the most likely diagnosis?
- A)Nephrolithiasis
- B)Papillary necrosis
- C)Poststreptococcal glomerulonephritis
- D)Acute tubular necrosis
- E)Acute interstitial nephritisGABARITO
Explicação
Acute interstitial nephritis is correct. The combination of recent drug exposure, fever, rash, eosinophiluria, and white cell casts is classic for a hypersensitivity reaction involving the renal interstitium. Common causes include antibiotics, proton pump inhi... Ver explicação completa e trilha adaptativa →