Interstitial nephritis natural history, complications and prognosis

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.

It has been suggested that the long-term prognosis is worse if:

• Renal failure lasts for >3 weeks.
• Older patients
• 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

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.