A 41-year-old man with HIV infection (CD4 count 45 cells/μL) is found unresponsive with seizures. Head CT shows mass lesions. He is started empirically on trimethoprim-sulfamethoxazole for presumed Pneumocystis jirovecii prophylaxis. After 5 days, creatinine rises from 1.0 to 2.4 mg/dL, potassium is 6.2 mEq/L, and urinalysis shows pyuria and eosinophils. Which of the following is the most likely diagnosis?
- A)Acute tubular necrosis from volume depletion
- B)Opportunistic infection of the kidney from CMV
- C)Acute interstitial nephritis from trimethoprim-sulfamethoxazoleGABARITO
- D)Trimethoprim-induced hyperkalemia with prerenal azotemia
- E)HIV-associated nephropathy with collapsing focal segmental glomerulosclerosis
Explicação
Acute interstitial nephritis (AIN) is a common adverse effect of trimethoprim-sulfamethoxazole, particularly in patients with advanced HIV. The combination of acute creatinine rise, pyuria, eosinophiluria (allergic response), hyperkalemia (trimethoprim inhibit... Ver explicação completa e trilha adaptativa →