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 Chronic Interstitial Nephritis

 Chronic Interstitial Nephritis

Discussion

A 55-year-old man presents to the nephrology clinic with complaints of progressive fatigue, weakness, and decreased appetite over the past six months. He has a significant history of long-standing hypertension and chronic pain, for which he has been taking non-steroidal anti-inflammatory drugs (NSAIDs) regularly. Recently, he has also noticed increased thirst and more frequent urination, particularly at night.

On examination, he appears slightly dehydrated and has a blood pressure of 145/90 mmHg. Laboratory tests reveal a serum creatinine level of 2.5 mg/dL, indicating chronic kidney disease. A urinalysis shows mild proteinuria and the presence of white blood cells and epithelial cells, but no casts or significant hematuria. A kidney ultrasound demonstrates normal-sized kidneys with no obstructive lesions.

Given his clinical history and findings, the patient is diagnosed with chronic interstitial nephritis, likely due to chronic NSAID use and longstanding hypertension. He is advised to discontinue NSAIDs and is started on an angiotensin-converting enzyme (ACE) inhibitor to manage his blood pressure and protect renal function. The patient is educated on the importance of regular follow-up, lifestyle modifications, including dietary changes and hydration, and the need to monitor his kidney function over time. Follow-up appointments are scheduled every three months to assess his renal status and adjust treatment as needed.

Questions
1. What underlying condition is most likely contributing to the patient's chronic interstitial nephritis? 

a) Diabetes mellitus

b) Long-standing hypertension and chronic NSAID use

c) Autoimmune disorder

d) Urinary tract infection

2. Which symptom did the patient report that is commonly associated with chronic interstitial nephritis?

a) Severe abdominal pain

b) Weight gain

c) Increased thirst and nocturia

d) Jaundice

3. What laboratory finding indicates a decline in the patient’s kidney function?

a) Normal urinalysis

b) Elevated serum creatinine level

c) High blood glucose level

d) Low haemoglobin count

4. What medication is the patient started on to help manage his condition?

a) Diuretic

b) Corticosteroids

c) Angiotensin-converting enzyme (ACE) inhibitor

d) Antidepressant

Reveal answers

Answers

  1. b) Long-standing hypertension and chronic NSAID use
  2. c) Increased thirst and nocturia
  3. b) Elevated serum creatinine level
  4. c) Angiotensin-converting enzyme (ACE) inhibitor