new_n_lost
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A 68-year-old female who recently had a cholecystectomy develops a fever of 103°F and has persistent drainage from her biliary catheter. She is given cephalothin and gentamicin for 10 days. Her serum creatinine level increases to 7.6 mg/dL. Her urine output is 1.3 L/day and has not diminished over the past few days. There is no history of hypotension and her vital signs are normal. Renal ultrasonography shows no evidence of obstruction. The most likely etiology of the patient's condition is
A. Acute glomerulonephritis
B. Acute renal failure secondary to cephalothin
C. Gentamicin nephrotoxicity
D. Renal artery occlusion
E. Sepsis
Edited by new_n_lost on 03/23/07 - 01:21 PM
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| shalini.ravi
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e 
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mediocricity aint my style
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| usmle4me
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E I thought but reading it again vital signs are normal and creatinine is raised
Excluding other left with C
NNL what is it??
Edited by usmle4me on 03/23/07 - 09:42 AM
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| keepgoing
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yes looks like c...
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| new_n_lost
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The correct answer is C
A small percentage of patients (5% to 10%) develop a non-oliguric form of acute renal failure when treated with aminoglycosides such as gentamicin. Gentamicin can accumulate in the kidney to produce a delayed form of acute renal failure resulting in an elevation of the serum creatinine level. The non-oliguric form of renal failure, seen in this patient, is the typical presentation for gentamicin nephrotoxicity.
Acute glomerulonephritis (choice A) is typically associated with hypertension and the appearance of active urinary sediment containing casts and red blood cells.
Cephalothin (choice B) is a first-generation cephalosporin commonly used in the treatment of severe infection of the genitourinary tract, gastrointestinal tract, and respiratory tract, as well as skin infections. This antibiotic can produce an acute interstitial nephritis; however, the patient's presentation is consistent with gentamicin nephrotoxicity. Interstitial nephritis is commonly associated with the development of acute renal failure, fever, rash, and eosinophilia.
Renal artery occlusion (choice D) is commonly caused by thrombosis or embolism. The clinical features of acute renal artery occlusion are hematuria, flank pain, fever, nausea, elevated LDH, elevated SGOT and acute renal failure.
Since the patient has normal vital signs and no history of hypotension, a diagnosis of sepsis (choice E) is unlikely
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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