American Board of Internal Medicine (ABIM) Certification Practice Exam

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Drug-induced Acute Interstitial Nephritis (AIN) is generally characterized by an increase in serum creatinine after how many days of exposure?

1 to 3 days
3 to 5 days
7 to 10 days
11 to 14 days

The correct answer is: 7 to 10 days

Drug-induced Acute Interstitial Nephritis (AIN) typically manifests after a period of exposure to the offending agent, with the increase in serum creatinine usually observed between 7 to 10 days. AIN is an inflammatory condition of the renal interstitium, often triggered by medications, and the delayed onset reflects the time required for the accumulation of immune mediators and the resultant inflammatory response. During this 7 to 10-day window, the affected individual may not show any immediate symptoms, making it crucial for clinicians to be aware of the potential for this condition in patients who begin new medications. The timeline correlates with the immune-mediated nature of AIN, as it necessitates prior sensitization to the drug in question or a cumulative effect of drug exposure before an immune response can produce significant renal impairment. Recognizing the typical timeline for the development of AIN aids in early diagnosis and management, which is key to preventing long-term kidney damage. Therefore, understanding this duration reinforces the importance of monitoring renal function after starting medications known to potentially cause AIN.