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NBME 20 Answers

nbme20/Block 3/Question#13 (27.3 difficulty score)
A 45-year-old woman develops proteinuria and ...
Tubulointerstitial nephritisπŸ”
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 +4 
submitted by hayayah(1057),
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hungrybox  But how is a 2-year history acute? +4  
jinzo  there is also " Chronic interstitial disease " +4  
targetmle  i got it wrong because there wasnt rash, also there was proteinuria, doesnt it indicate glomerular involvement? +2  
zevvyt  Got it wrong too cuz of that. But there can be proteinuria in nephritis, just not as much as in nephrotic syndrome. I guess that's confusing cuz this type of nephritis isn't grouped with the other nephritic conditions. +1  
lovebug  FA 2019, Page 591. +  

I think this can either be acute or chronic tubulointerstitial nephritis. According to MSDmanuals, 'acute' TIN symptom onset can occur 18 months after NSAID use. The classic triad of fever, urticaria, and eosinophilia is only present in <10% of cases. Also, they can have proteinuria (<1 g/day) or even nephrotic-range proteinuria (>3.5 g/day) if it's caused by NSAIDs.

+1/- fatboyslim(39),

This is the link to my source: https://www.msdmanuals.com/professional/genitourinary-disorders/tubulointerstitial-diseases/tubulointerstitial-nephritis

Sorry forgot to post in same comment

+/- fatboyslim(39),


 +1 
submitted by apple222(1),

proteinuria + hematuria, chronic analgesic abuse -> renal papillary necrosis , which can be a progression from acute interstitial nephritis (drug-induced hypersensitivity involving the interstitium and tubules)

Pathoma19 p127