Answer to the last #DiagnosticDilemma
The correct answer is D. Tubulointerstitial disease

This patient has tubulointerstitial disease, likely due to long-standing exposure to tenofovir. Evidence for a tubulointerstitial process includes a slowly progressive course without a clear inciting event, subnephrotic proteinuria, bland urine sediment, and a kidney ultrasound showing atrophic kidneys.

History and physical examination should focus on conditions associated with tubulointerstitial disease and a careful review of medications, because numerous medications may induce tubulointerstitial disease.

An associated characteristic that may be present with tubulointerstitial disease is abnormal tubular handling of glucose, amino acids, uric acid, phosphate, and bicarbonate (termed Fanconi syndrome); renal tubular acidosis is also common. Patients may also have concentrating defects and may present with nocturia and polyuria. With more advanced disease, anemia may be present due to the destruction of erythropoietin-producing cells in the kidney.

This patient’s findings are consistent with tubulointerstitial disease with Fanconi syndrome, indicated by glucosuria in the context of normoglycemia, trace proteinuria, and hypophosphatemia. Because tenofovir has been associated with tubulointerstitial disease, it is the likely cause in this patient.

Major takeaway:-
Kidney disease with a tubulointerstitial process is characterized by a slowly progressive course without a clear inciting event, subnephrotic proteinuria, bland urine sediment, and a kidney ultrasound showing atrophic kidneys.

Know more here: https://pxmd.co/SWKK7
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