A 64-Year-Old Man Comes to the Office Due to Persistent

A 64-year-old man comes to the office due to persistent back pain, constipation, and easy fatigability for the last several months.  Blood pressure is 115/75 mm Hg and pulse is 88/min.  The patient has dry mucous membranes.  Laboratory results are as follows: Renal biopsy is performed and light microscopy shows atrophic tubules, many of which contain large, obstructing, waxy casts that stain intensely with eosin.  Which of the following is the most likely diagnosis in this patient?

A) Acute pyelonephritis
B) Aminoglycoside toxicity
C) Hypersensitivity interstitial nephritis
D) Ischemic tubular necrosis
E) Lead nephropathy
F) Multiple myeloma
G) Nonsteroidal anti-inflammatory drug-associated nephropathy
H) Papillary necrosis
I) Urate nephropathy

Correct Answer:

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