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| {{DiseaseDisorder infobox |
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| | '''For patient information, click [[Interstitial nephritis (patient information)|here]]''' |
| ICD10 = {{ICD10|N|10||n|10}}-{{ICD10|N|12||n|10}}|
| | {{Interstitial nephritis}} |
| ICD9 = {{ICD9|580.89}}, {{ICD9|581.89}}, {{ICD9|582.89}}, {{ICD9|583.89}} |
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| DiseasesDB = 6854 |
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| {{EH}} | | {{CMG}} {{AE}}{{M.B}}{{MMJ}} |
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| '''Interstitial nephritis ''' (or '''Tubulo-interstitial nephritis''') is a form of [[nephritis]] affecting the interstitium of the [[kidney]]s surrounding the [[Nephron#Renal_tubule|tubules]]. This disease can be either acute, which means it occurs suddenly or chronic, meaning it is ongoing and eventually ending in kidney failure. | | '''''Synonyms and keywords:''''' Tubulointerstitial Nephritis |
| | ==[[Interstitial nephritis overview|Overview]]== |
| | ==[[Interstitial nephritis historical perspective|Historical Perspective]]== |
| | ==[[Interstitial nephritis classification|Classification]]== |
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| ==Causes== | | ==[[Interstitial nephritis pathophysiology|Pathophysiology]]== |
| Common causes include infection, or reaction to medication (such as an [[analgesic]] or [[antibiotic]]s). 71%<ref name="pmid14671029">{{cite journal |author=Baker R, Pusey C |title=The changing profile of acute tubulointerstitial nephritis |journal=Nephrol Dial Transplant |volume=19 |issue=1 |pages=8-11 |year=2004 |pmid=14671029|url=http://ndt.oxfordjournals.org/cgi/content/full/19/1/8}}</ref> to 92%<ref name="pmid15340098">{{cite journal |author=Clarkson M, Giblin L, O'Connell F, O'Kelly P, Walshe J, Conlon P, O'Meara Y, Dormon A, Campbell E, Donohoe J |title=Acute interstitial nephritis: clinical features and response to corticosteroid therapy |journal=Nephrol Dial Transplant |volume=19 |issue=11 |pages=2778-83 |year=2004 |pmid=15340098}}</ref> of cases are reported to be caused by drugs. This disease is also caused by other diseases and toxins that do damage to the kidney. Both acute and chronic tubulointerstitial nephritis can be caused by a bacterial infection in the kidneys, known as [[pyelonephritis]]. The most common cause is by an allergic reaction to a drug. The drugs that are known to cause this sort of reaction are antibiotics such as penicillin, and nonsteroidal anti-inflammatory drugs, such as aspirin. The time between exposure to the drug and the development of acute tubulointerstitial nephritis can be anywhere from 5 days to 5 weeks.
| | ==[[Interstitial nephritis causes|Causes]]== |
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| ==Underlying Causes in Alphabetical Order== | | ==[[Interstitial nephritis differential diagnosis|Differentiating Interstitial nephritis from other Diseases]]== |
| *[[Acetaminophen]] ([[Tylenol]])
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| *[[Allopurinol]]
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| *[[Alport syndrome]]
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| *[[Ampicillin]]
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| *[[Aristolochia]]
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| *[[Aspirin]]
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| *[[Bardet-Biedl syndrome]]
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| *[[Bumetanide]]
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| *[[Cephalosporins]]
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| *[[Cimetidine]]
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| *[[Ciprofloxacin]]
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| *[[Cytomegalovirus]] infection
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| *[[Diphtheria]]
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| *[[Doxycycline]]
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| *[[Furosemide]]
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| *[[Griseofulvin]]
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| *[[Hydralazine]]
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| *[[Hypercalcimia]]
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| *Hyperkalaemic distal [[renal tubular acidosis]]
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| *[[Hyperuricemia]]
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| *[[Hypokalemia]]
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| *[[Indinavir]]
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| *[[Kawasaki's disease]]
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| *[[Lansoprazole]]
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| *[[Legionellosis]]
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| *[[Leptospirosis]]
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| *[[Mesalamine]]
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| *[[Methicillin]]
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| *[[Myeloma]]
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| *[[Omeprazole]]
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| *[[Oxytetracycline]]
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| *[[Penicillin]]
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| *[[Ranitidine]]<ref>Gaughan WJ, Sheth VR, Francos GC, Michael HJ, Burke JF. Ranitidine-induced acute interstitial nephritis with epithelial cell foot process fusion. Am J Kidney Dis. 1993;22(2):337.</ref><ref>Neelakantappa K, Gallo GR, Lowenstein J. Ranitidine-associated interstitial nephritis and Fanconi syndrome. Am J Kidney Dis. 1993;22(2):333.</ref>
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| *[[Reflux nephropathy]]
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| *[[Renal failure]]
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| *[[Rifampin]]
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| *[[Sensenbrenner syndrome]]
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| *[[Sicca syndrome]]
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| *[[Sickle cell disease]]
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| *[[Sjogren syndrome]]
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| *[[Streptococcal infection]]
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| *[[Streptomycin]]
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| *[[Sulfonamide]]
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| *[[Systemic lupus erythematosus]]
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| *[[Thiazide]] diuretics
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| *[[Triamterene]]
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| *[[Trimethoprim-sulfamethoxazole]]
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| *[[Wegener's granulomatosis]]
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| | ==[[Interstitial nephritis epidemiology and demographics|Epidemiology and Demographics]]== |
| | ==[[Interstitial nephritis risk factors|Risk Factors]]== |
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| | ==[[Interstitial nephritis natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| ==Diagnosis== | | ==Diagnosis== |
| At times there are no symptoms of this disease, but when they do occur they are widely varied and can occur rapidly or gradually<ref name="pmid11473672">{{cite journal |author=Rossert J |title=Drug-induced acute interstitial nephritis |journal=Kidney Int |volume=60 |issue=2 |pages=804-17 |year=2001 |pmid=11473672 | url=http://www.nature.com/ki/journal/v60/n2/full/4492487a.html | doi=10.1046/j.1523-1755.2001.060002804.x}}</ref><ref name="pmid14671029">.</ref><ref name="pmid6604293">{{cite journal |author=Pusey C, Saltissi D, Bloodworth L, Rainford D, Christie J |title=Drug associated acute interstitial nephritis: clinical and pathological features and the response to high dose steroid therapy |journal=Q J Med |volume=52 |issue=206 |pages=194-211 |year=1983 |pmid=6604293}}</ref><ref name="pmid3779558">{{cite journal |author=Handa S |title=Drug-induced acute interstitial nephritis: report of 10 cases |journal=CMAJ |volume=135 |issue=11 |pages=1278-81 |year=1986 |pmid=3779558}}</ref><ref name="pmid2113219">{{cite journal |author=Buysen J, Houthoff H, Krediet R, Arisz L |title=Acute interstitial nephritis: a clinical and morphological study in 27 patients |journal=Nephrol Dial Transplant |volume=5 |issue=2 |pages=94-9 |year=1990 |pmid=2113219}}</ref>. When caused by an allergic reaction, the symptoms of acute tubulointerstitial nephritis are fever (27% of patients)<ref name="pmid14671029">.</ref>, rash (15% of patients)<ref name="pmid14671029">.</ref>, and enlarged kidneys. Some people experience [[dysuria]], and lower back pain. In chronic tubulointerstitial nephritis the patient can experience symptoms such as nausea, vomiting, fatigue, and weight loss. Other conditions that may develop include [[hyperkalemia]], [[metabolic acidosis]], and kidney failure.
| | [[Interstitial nephritis history and symptoms|History and Symptoms]] | [[Interstitial nephritis physical examination|Physical Examination]] | [[Interstitial nephritis laboratory findings|Laboratory Findings]] | [[Interstitial nephritis KUB x ray|KUB X Ray]] | [[Interstitial nephritis CT|CT]] | [[Interstitial nephritis MRI|MRI]] | [[Interstitial nephritis biopsy and ultrasound|Biopsy and Ultrasound]] | [[Interstitial nephritis other imaging findings|Other Imaging Findings]] | [[Interstitial nephritis other diagnostic studies|Other Diagnostic Studies]] |
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| ===Blood tests===
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| About 23% of patients have [[eosinophilia]]<ref name="pmid14671029">.</ref>.
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| ===Urinary findings===
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| Urinary findings include:
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| * [[Eosinophiluria]]: [[sensitivity (tests)|sensitivity]] is 67% and [[specificity (tests)|specificity]] is 83% <ref name="pmid11473672">.</ref><ref name="pmid11020015">{{cite journal |author=Schwarz A, Krause P, Kunzendorf U, Keller F, Distler A |title=The outcome of acute interstitial nephritis risk factors for the transition from acute to chronic interstitial nephritis |journal=Clin Nephrol |volume=54 |issue=3 |pages=179-90 |year=2000 |pmid=11020015}}</ref>. The [[sensitivity (tests)|sensitivity]] is higher in patients with interstitial nephritis induced by [[methicillin]] or when the Hansel's stain is used.
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| * [[Isosthenuria]] <ref name="pmid3769228">{{cite journal |author=Lins R, Verpooten G, De Clerck D, De Broe M |title=Urinary indices in acute interstitial nephritis |journal=Clin Nephrol |volume=26 |issue=3 |pages=131-3 |year=1986 |pmid=3769228}}</ref>
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| ===Gallium scan===
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| The [[sensitivity (tests)|sensitivity]] of an abnormal [[gallium scan]] has been reported to range from 60%<ref name="pmid6864309">{{cite journal |author=Graham G, Lundy M, Moreno A |title=Failure of Gallium-67 scintigraphy to identify reliably noninfectious interstitial nephritis: concise communication |journal=J Nucl Med |volume=24 |issue=7 |pages=568-70 |year=1983 |pmid=6864309}}</ref> to 100%<ref name="pmid3862487">{{cite journal |author=Linton A, Richmond J, Clark W, Lindsay R, Driedger A, Lamki L |title=Gallium67 scintigraphy in the diagnosis of acute renal disease |journal=Clin Nephrol |volume=24 |issue=2 |pages=84-7 |year=1985 |pmid=3862487}}</ref>.
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| ==Treatment== | | ==Treatment== |
| Remove the etiology such as an offending drug. [[Corticosteroids]] do not clearly help <ref name="pmid15340098">.</ref>.
| | [[Interstitial nephritis medical therapy|Medical Therapy]] | [[Interstitial nephritis primary prevention|Primary Prevention]] | [[Interstitial nephritis secondary prevention|Secondary Prevention]] | [[Interstitial nephritis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Interstitial nephritis future or investigational therapies|Future or Investigational Therapies]] |
| Nutrition therapy consists of adequate fluid intake, which can require several liters of extra fluid.{{cite book |coauthors= Mahan KL, Escott-Stump S |editor= Alexopolos Y |title= Krause's Food, Nutrition, & Diet Therapy|edition= 11th|publisher= Saunders |location= Philadelphia Pennsylvania |language= English |isbn= 0-7216-9784-4|pages= 968 |chapter= 39}}
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| ==Prognosis==
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| The kidneys are the only body system that is directly affected by tubulointerstitial nephritis. Kidney function is usually reduced; the kidneys can be just slightly dysfunctional, or fail completely.
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| In chronic tubulointerstitial nephritis the most serious long term effect is kidney failure. When the proximal tube is injured sodium, potassium, bicarbonate, uric acid, and phosphate intake may be reduced or changed, resulting in low bicarbonate, known as metabolic acidosis, low potassium, low uric acid known as hypouricemia, and low phosphate known as hypophosphatemia. Damage to the distal tubule may cause loss of urine concentrating ability and [[polyuria]].
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| In most cases of acute tubulointerstitial nephritis, the function of the kidneys will return after the harmful drug is not taken anymore, or when the underlying disease is cured by treatment. If the illness is caused by an allergic reaction, a corticosteroid may speed the recovery kidney function, however this is often not the case. Chronic tubulointerstitial nephritis has no cure. Some patients may require [[dialysis]]. Eventually, a kidney transplant may be needed.
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| ==References== | | ==Case Studies== |
| {{Reflist|2}}
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| ==External links==
| | [[Interstitial nephritis case study one|Case #1]] |
| * [http://www.merck.com/mmpe/sec17/ch236/ch236c.html Merck Manual]
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| {{Nephrology}} | | {{Nephrology}} |
| {{SIB}}
| | [[Category:Disease]] |
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| [[Category:Kidney diseases]] | | [[Category:Kidney diseases]] |
| | [[Category:Urology]] |
| | [[Category:Emergency medicine]] |
| | [[Category:Intensive care medicine]] |
| [[de:Interstitielle Nephritis]] | | [[de:Interstitielle Nephritis]] |
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| {{WH}} | | {{WH}} |
| {{WS}} | | {{WS}} |
| | <references /> |