In a patient with rheumatoid arthritis treated with methotrexate, prednisone and indomethacin who acutely presents edema and increased plasma creatinine with a poorly expressive urine sediment and proteinuria less than 100 mg/24 h the most likely cause is:
Prerenal acute renal failure due to NSAIDs seems the most plausible option in this case. Tubulointerstitial nephritis due to methotrexate is less likely due to the absence of rash, fever or eosinophilia, which although rare in the MIR usually appear. Although GMN and renal amyloidosis are relatively frequent in RA, the anodyne urine sediment and the absence of proteinuria make these options unlikely.
Renal amyloidosis.
Glomerulonephritis secondary to rheumatoid arthritis.
Renal failure due to non-steroidal anti-inflammatory drugs.
Interstitial nephritis due to methotrexate.
Although GMN and renal amyloidosis are relatively frequent in RA, the anodyne urine sediment and the absence of proteinuria make these options unlikely.
Prerenal acute renal failure due to NSAIDs seems the most plausible option in this case.
Tubulointerstitial nephritis due to methotrexate is less likely due to the absence of rash, fever or eosinophilia, which although rare in the MIR usually appear.