Interstitial nephritis: Difference between revisions

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Latest revision as of 01:33, 18 September 2019

For patient information, click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohsen Basiri M.D.Mohamadmostafa Jahansouz M.D.[2]

Synonyms and keywords: Tubulointerstitial Nephritis

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Interstitial nephritis from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

Treatment

Medical Therapy | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1

Template:Nephrology de:Interstitielle Nephritis

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@@ Line 1: / Line 1: @@
 __NOTOC__
 '''For patient information, click [[Interstitial nephritis (patient information)|here]]'''
 {{Interstitial nephritis}}
-{{CMG}} {{AE}}{{M.B}}
+{{CMG}} {{AE}}{{M.B}}{{MMJ}}
-'''''Synonyms and keywords:''''' Tubulo-interstitial nephritis
+'''''Synonyms and keywords:''''' Tubulointerstitial Nephritis
 ==[[Interstitial nephritis overview|Overview]]==
-Two main diseases involve the renal tubules are:  Acute tubular necrosis due to Ischemic or toxic injury for more about ATN click [[Acute tubular necrosis|here]]; and tubulointerstitial nephritis with Inflammatory involvement of tubules and interstitium and its consequent  reactions.
-Since some  cases of TIN are due  to bacterial infection, and the renal pelvis is deeply involved, therefore [[pyelonephritis]] is term describes this condition; and In general ,the term interstitial nephritis is used for TIN that are owing to  nonbacterial causes of tubular injury such as  drugs, viral infections,autoimmune systemic diseases  in which these condition mechanism of damage is due to inflammatory responses not direct damage.
 ==[[Interstitial nephritis historical perspective|Historical Perspective]]==
-* In 1938, Councilman was the first to discover the association between systemic infections and the development of TIN; in autopsy kidneys of children dying of diphtheria and scarlet fever.
-* He described the findings as: cellular and fluid exudation in the interstitial tissue of kidneys, before the era of antibiotics.
-* The widespread introduction of percutaneous renal biopsy led to the discovery of similar findings in association with drug-related renal failure.Histological examination in ATIN reveals an infiltrate, which is largely composed of T cells, together with some macrophages and plasma cells.
 ==[[Interstitial nephritis classification|Classification]]==
-There is no established system for the classification of TIN, however according to clinical manifestations and the  inflammatory process, TIN, in spite of the etiologic agent, can be divided into acute and chronic categories.
 ==[[Interstitial nephritis pathophysiology|Pathophysiology]]==
-It is thought that acute interstitial nephritis is mediated by [[hypersensitivity reaction]] to endogenous or exogenous [[antigens]]<nowiki/>expressed by [[Nephron|tubular cells]]. Numerous drugs such as [[antibiotics]], NSAIDS, [[Sulfa-containing antibiotics|sulfa-containing]] drugs, etc, as well as systemic diseases, and Infections may lead injury to renal cells. the cascade activation owing to cellular injury toward inflammatory cell infiltration, and activation of cytokines causes an immunologic reaction in acute or chronic process.
-In acute interstitial nephritis, this cascade activation can cause renal tubular dysfunction, whereas in chronic interstitial nephritis an insidious interstitial [[fibrosis]],[[scarring]], , and tubular atrophy spreads gradually and causes progressive [[chronic renal insufficiency]].
 ==[[Interstitial nephritis causes|Causes]]==
-Common causes of interstitial nephritis include drug side effects, particularly [[analgesics]] and [[antibiotics]]. Other common causes include associated nephrologic conditions, as well as [[microbial]] infections.
 ==[[Interstitial nephritis differential diagnosis|Differentiating Interstitial nephritis from other Diseases]]==
 ==[[Interstitial nephritis epidemiology and demographics|Epidemiology and Demographics]]==
-Interstitial nephritis accounts for 10-15% of kidney disease worlwide.
-Analgesic-induced nephritis is 5-6 times more common in women.
-The elderly have more severe disease and increased risk of permanent damage.
-Children exposed to lead poisoning are more likely to develop nephritis as young adult.
-TIN with uveitis is more common in adolescent female.
 ==[[Interstitial nephritis risk factors|Risk Factors]]==
-There are no established risk factors for TIN. Whereas according to etiologic causative factors, consumption of culprit drugs in causing TIN,previous history of hypersensitivity reactions to specific drug, presence of autoimmune systemic disease or some neoplasia or genetic condition, occupational or environmental exposure to heavy metals , and infection etiologies in association with obstructive uropathy, play role in in the development of TIN
 ==[[Interstitial nephritis natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
-In the majority of patients with TIN, recovery of [[renal function]] has been observed, and improvement immediately occurs upon stopping the offensive agent.
-Nevertheless, about 12% of patients may progress to develop [[ESRD]] and its complications; and thus require [[dialysis]] or [[Organ transplant|transplantation]].
-However there is no definite prognostic indicators for TIN, but [[Renal insufficiency|renal failure]] lasts for >3 weeks, older patients and presence of tubular atrophy and [[interstitial fibrosis]] in the renal biopsy are associated with worse prognosis.
 ==Diagnosis==
 [[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]]

Interstitial nephritis: Difference between revisions

Latest revision as of 01:33, 18 September 2019

Diagnosis

Treatment

Case Studies

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