A 47-Year-Old Man Is Treated for Bacterial Sinusitis with Ampicillin

A 47-year-old man is treated for bacterial sinusitis with ampicillin.  A week later he comes to the emergency department with fever and a skin rash.  He also reports low urine output.  Temperature is 37.5 C (99.5 F) , blood pressure is 123/71 mm Hg, and pulse is 88/min.  Physical examination shows a diffuse maculopapular rash.  Serum creatinine level is 2.4 mg/dL, and urine sediment microscopy reveals 3-4 red blood cells/hpf, 5-10 white blood cells/hpf, and 3-5 eosinophils/hpf.  The pathologic process affecting this patient's kidneys most likely involves which of the following structures?

A) Calyces and ureters
B) Glomeruli
C) Renal interstitium
D) Renal papillae
E) Small renal arterioles

Correct Answer:

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