QuestionSBA
QuestionChoice
There are no worrying signs of any significant kidney injury, the patient's vital signs and physical examination are unremarkable, and the patient is otherwise stable. Therefore, referring the patient to a specialist for further review would not be necessary.
62076
d
Refer to a specialist for further review
QuestionChoice
This patient has only been taking paracetamol for the past week, so it is unlikely to have caused any kidney injury. Additionally, the patient has been diagnosed with osteoarthritis, and paracetamol is a safe and effective treatment for her pain. Analgesic nephropathy is due to the long-term use of paracetamol, aspirin or NSAIDs.
62077
e
Discontinue paracetamol
QuestionChoice
Regular monitoring of creatinine levels may not provide additional information, as there will be no evidence of renal damage. Moreover, it is an unnecessary burden on healthcare resources.
62075
c
Monitor creatinine levels daily
QuestionChoice
A transient increase in serum creatinine level is an expected effect of trimethoprim, which is not harmful as it returns to normal after stopping the medication. Switching antibiotics unnecessarily can lead to resistance. Therefore, replacing trimethoprim with another antibiotic is not recommended.
62074
b
Replace trimethoprim with another antibiotic
QuestionChoice
Trimethoprim causes a **transient rise in creatinine levels** by decreasing renal creatinine excretion rather than a sign of acute kidney injury. Moreover, there is a high chance of developing hyperkalaemia due to inhibition of the uptake of sodium in the distal tubule, leading to less urine potassium and an accumulation of potassium in the blood. Both of these changes are reversible, and the values return to normal after withdrawing the drug.
62073
a
No action needed
QuestionComment
But her creatinine rise is about x1.5 of her old creatinine level?
28939
User
subscriber
anon
Concept
Chapter
# Pathophysiology

Trimethoprim can lead to a transient rise in creatinine levels by reducing the creatinine excretion of the kidneys. 

This does NOT reflect the actual GFR and therefore this phenomenon is not reflective of an Acute kidney injury but rather the calculated eGFR due to a transient rise in Creatinine.
1784
1968
Trimethoprim and renal function
Topic
33
Nephrology
12476
A 70-year-old woman has been seen at the GP clinic for a review of her bloods. A week ago, she complained of burning micturition, dysuria, and lower pelvic pain. She was diagnosed with urinary tract infection and was started on trimethoprim. Past medical history includes chronic obstructive pulmonary disease, coronary artery disease, rheumatoid arthritis, and type 2 diabetes mellitus. She takes ipratropium bromide and salbuterol inhalers, aspirin, clopidogrel, atorvastatin, ciclosporin, and metformin.


Her vital signs and physical examination are unremarkable. A week ago,
Creatinine: 89 µmol/L (60-120 µmol/L)
Urinalysis: 0-1 RBCs, 0-2 WBCs, 5-10 hyaline casts.


Her recent blood tests reveal:
Creatinine: 140 µmol/L (60-120 µmol/L)


Given the blood results, what is the best course of action?
a