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|toxic injury]] .(for more about ATN click [[Acute tubular necrosis|here]]), and tubulointerstitial nephritis (TIN) with [[Inflammatory]] involvement of tubules and [[interstitium]] and its consequent  reactions.
-Since some  cases of involvement of renal tubulointerstitium 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 disease|autoimmune systemic diseases]] , in which these condition mechanism of damage is due to activation of [[inflammatory responses]] not direct damage of [[Pathogens|microbial pathogens]].
 ==[[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 use of renal biopsy and histological examination in TIN revealed a cellular  infiltration, which is dominantly  composed of [[T cells]], together with some [[macrophages]] and [[plasma cells]], and led to the discovery of similar findings in association with drug-related [[Renal insufficiency and failure|renal failure]] and the same conditions.
 ==[[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]] 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 [[Atrophy|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 worldwide. [[Nephritis|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.
 ==[[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 disease|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

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