Interstitial nephritis natural history, complications and prognosis: Difference between revisions
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==Prognosis== | ==Prognosis== | ||
In the majority of patients with TIN, a full recovery or partial recovery occurs upon stopping the offensive agent. Meanwhile,about 12% of patients may progress to ESRD and its complications; and thus require dialysis or transplantation. | In the majority of patients with TIN, a full recovery or partial recovery occurs upon stopping the offensive agent. Meanwhile,about 12% of patients may progress to ESRD and its complications; and thus require dialysis or transplantation.<ref name="BakerPusey2004">{{cite journal|last1=Baker|first1=R. J.|last2=Pusey|first2=C. D.|title=The changing profile of acute tubulointerstitial nephritis|journal=Nephrology Dialysis Transplantation|volume=19|issue=1|year=2004|pages=8–11|issn=0931-0509|doi=10.1093/ndt/gfg464}}</ref> | ||
==== It has been suggested that the long-term prognosis is worse if: ==== | ==== It has been suggested that the long-term prognosis is worse if: ==== | ||
* Renal failure lasts for >3 weeks.<ref>Ditlove J, Weidmann P, Bernstein M, Massry SG. Methicillin nephritis. Med Balt 1977; 56: 483–491</ref><ref>Laberke HG, Bohle A. Acute interstitial nephritis: correlations between clinical and morphological findings. Clin Nephrol 1980; 14: 263–273</ref> <ref /> | * Renal failure lasts for >3 weeks.<ref>Ditlove J, Weidmann P, Bernstein M, Massry SG. Methicillin nephritis. Med Balt 1977; 56: 483–491</ref><ref>Laberke HG, Bohle A. Acute interstitial nephritis: correlations between clinical and morphological findings. Clin Nephrol 1980; 14: 263–273</ref> <ref /> | ||
* Older patients<ref>Kida H, Abe T, Tomosugi N et al. Prediction of the long-term outcome in acute interstitial nephritis. Clin Nephrol 1984; 22: 55–60</ref> | * Older patients<ref>Kida H, Abe T, Tomosugi N et al. Prediction of the long-term outcome in acute interstitial nephritis. Clin Nephrol 1984; 22: 55–60</ref> | ||
* Presence of tubular atrophy and interstitial fibrosis in the renal biopsy.<ref /> <ref /> | * Presence of tubular atrophy and interstitial fibrosis in the renal biopsy.<ref />Kida H, Abe T, Tomosugi N et al. Prediction of the long-term outcome in acute interstitial nephritis. Clin Nephrol 1984; 22: 55–60<ref /> <ref>Bhaumik SK, Kher V, Arora P et al. Evaluation of clinical and histological prognostic markers in drug-induced acute interstitial nephritis. Ren Fail 1996; 18: 97–104</ref> | ||
In chronic tubulointerstitial nephritis the most serious long term effect is [[kidney failure]]. When the proximal tubule is injured sodium, potassium, bicarbonate, uric acid, and phosphate intake may be reduced or changed, resulting in [[metabolic acidosis]], [[hypokalemia]], [[hypouricemia]], [[hypophosphatemia]]. Damage to the distal renal tubule may cause loss of urine concentrating ability and [[polyuria]]. | In chronic tubulointerstitial nephritis the most serious long term effect is [[kidney failure]]. When the proximal tubule is injured sodium, potassium, bicarbonate, uric acid, and phosphate intake may be reduced or changed, resulting in [[metabolic acidosis]], [[hypokalemia]], [[hypouricemia]], [[hypophosphatemia]]. Damage to the distal renal tubule may cause loss of urine concentrating ability and [[polyuria]]. | ||
Revision as of 23:44, 19 July 2018
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [[1]]; Associate Editor(s)-in-Chief:Mohsen Basiri M.D.
Overview
In the majority of patients with TIN, recovery of 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 transplantation.
Natural History, Complications, and Prognosis
Natural History
- The symptoms of (disease name) usually develop in the first/ second/ third decade of life, and start with symptoms such as ___.
- The symptoms of (disease name) typically develop ___ years after exposure to ___.
- If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
Complications
- Common complications of TIN include:
- Hypertension
- Electrolyte and acid-base disorders
- ESRD
Prognosis
In the majority of patients with TIN, a full recovery or partial recovery occurs upon stopping the offensive agent. Meanwhile,about 12% of patients may progress to ESRD and its complications; and thus require dialysis or transplantation.[1]
It has been suggested that the long-term prognosis is worse if:
- Renal failure lasts for >3 weeks.[2][3]
- Older patients[4]
- Presence of tubular atrophy and interstitial fibrosis in the renal biopsy.Kida H, Abe T, Tomosugi N et al. Prediction of the long-term outcome in acute interstitial nephritis. Clin Nephrol 1984; 22: 55–60 [5]
In chronic tubulointerstitial nephritis the most serious long term effect is kidney failure. When the proximal tubule is injured sodium, potassium, bicarbonate, uric acid, and phosphate intake may be reduced or changed, resulting in metabolic acidosis, hypokalemia, hypouricemia, hypophosphatemia. Damage to the distal renal tubule may cause loss of urine concentrating ability and polyuria.
References
- ↑ Baker, R. J.; Pusey, C. D. (2004). "The changing profile of acute tubulointerstitial nephritis". Nephrology Dialysis Transplantation. 19 (1): 8–11. doi:10.1093/ndt/gfg464. ISSN 0931-0509.
- ↑ Ditlove J, Weidmann P, Bernstein M, Massry SG. Methicillin nephritis. Med Balt 1977; 56: 483–491
- ↑ Laberke HG, Bohle A. Acute interstitial nephritis: correlations between clinical and morphological findings. Clin Nephrol 1980; 14: 263–273
- ↑ Kida H, Abe T, Tomosugi N et al. Prediction of the long-term outcome in acute interstitial nephritis. Clin Nephrol 1984; 22: 55–60
- ↑ Bhaumik SK, Kher V, Arora P et al. Evaluation of clinical and histological prognostic markers in drug-induced acute interstitial nephritis. Ren Fail 1996; 18: 97–104