Interstitial nephritis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords: Tubulo-interstitial nephritis
Overview
Interstitial nephritis (or Tubulo-interstitial nephritis) is a form of nephritis affecting the interstitium of the kidneys surrounding the tubules. This disease can be either acute, which means it occurs suddenly or chronic, meaning it is ongoing and eventually ending in kidney failure.
Causes
Common causes include infection, or reaction to medication (such as an analgesic or antibiotics). 71%[1] to 92%[2] 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.
Underlying Causes in Alphabetical Order
- Acetaminophen (Tylenol)
- Acyclovir
- Aldomet
- Allopurinol
- Alpha-interferon
- Alport syndrome
- Amlodipine[3]
- Ampicillin
- Aristolochia
- Aspirin
- Azathioprine
- Bardet-Biedl syndrome
- Bumetanide
- Captopril
- Carbamazepine
- Cephalosporins
- Chlorthalidone
- Cimetidine
- Ciprofloxacin[4]
- Clofibrate
- Cocaine
- Creatine[5]
- Cytomegalovirus infection
- Diazepam
- Diclofenac
- Diflunisal
- Diltiazem[6]
- Diphenylhydantoin
- Diphtheria
- Doxycycline
- Epstein-Barr virus infection
- Erythromycin
- Ethambutol
- Famotidine
- Fenoprofen
- Furosemide
- Griseofulvin
- Hantaan virus
- HIV infection
- Hydralazine
- Hypercalcimia
- Hyperkalaemic distal renal tubular acidosis
- Hyperuricemia
- Hypokalemia
- Ibuprofen
- Indinavir
- Indomethacin
- Isoniazid
- Kawasaki's disease
- Ketoprofen
- Lansoprazole
- Legionellosis
- Leishmaniosis
- Leptospirosis
- Macrolides
- Mesalamine
- Mesalazine[7]
- Methicillin
- Mycoplasma infection
- Myeloma
- Naproxen
- Omeprazole[8]
- Omeprazole
- Oxacillin
- Oxytetracycline
- Penicillin
- Phenindione
- Phenobarbital
- Phenteramine[9]
- Phenylpropanolamine
- Phenytoin
- Piroxicam
- Polymyxin
- Pranlukast[10]
- Propylthioruacil[11]
- Quinine
- Ranitidine[12][13]
- Reflux nephropathy
- Renal failure
- Rickettsia infection
- Rifampin
- Rubeola infection
- Sensenbrenner syndrome
- Sicca syndrome
- Sickle cell disease
- Sjogren syndrome
- Streptococcal infection
- Streptomycin
- Sulfinpyrazone
- Sulfonamide
- Syphilis
- Systemic lupus erythematosus
- Tetracycline
- Thiazide diuretics
- Tolmetin
- Toxoplasmosis
- Triamterene
- Triamterene
- Trimethoprim-sulfamethoxazole
- Vancomycin[14]
- Wegener's granulomatosis
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[15][1][16][17][18]. When caused by an allergic reaction, the symptoms of acute tubulointerstitial nephritis are fever (27% of patients)[1], rash (15% of patients)[1], 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.
Blood tests
About 23% of patients have eosinophilia[1].
Urinary findings
Urinary findings include:
- Eosinophiluria: sensitivity is 67% and specificity is 83% [15][19]. The sensitivity is higher in patients with interstitial nephritis induced by methicillin or when the Hansel's stain is used.
- Isosthenuria [20]
Gallium scan
The sensitivity of an abnormal gallium scan has been reported to range from 60%[21] to 100%[22].
Treatment
Remove the etiology such as an offending drug. Corticosteroids do not clearly help [2].
Nutrition therapy consists of adequate fluid intake, which can require several liters of extra fluid.Alexopolos Y (ed.). "39". Krause's Food, Nutrition, & Diet Therapy (11th ed.). Philadelphia Pennsylvania: Saunders. p. 968. ISBN 0-7216-9784-4. Unknown parameter |coauthors= ignored (help)
Prognosis
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.
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 low bicarbonate, known as metabolic acidosis, hypokalemia, low uric acid (hypouricemia, and low phosphate (hypophosphatemia). Damage to the distal renal tubule may cause loss of urine concentrating ability and polyuria.
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.
References
- ↑ 1.0 1.1 1.2 1.3 1.4 Baker R, Pusey C (2004). "The changing profile of acute tubulointerstitial nephritis". Nephrol Dial Transplant. 19 (1): 8–11. PMID 14671029.
- ↑ 2.0 2.1 Clarkson M, Giblin L, O'Connell F, O'Kelly P, Walshe J, Conlon P, O'Meara Y, Dormon A, Campbell E, Donohoe J (2004). "Acute interstitial nephritis: clinical features and response to corticosteroid therapy". Nephrol Dial Transplant. 19 (11): 2778–83. PMID 15340098.
- ↑ Ejaz AA, Fitzpatrick PM, Haley WE, Wasiluk A, Durkin AJ, Zachariah PK (2000). "Amlodipine besylate induced acute interstitial nephritis". Nephron. 85 (4): 354–6. PMID 10940749. Retrieved 2012-02-12. Unknown parameter
|month=ignored (help) - ↑ Andrews PA, Robinson GT (1999). "Intravascular haemolysis and interstitial nephritis in association with ciprofloxacin". Nephron. 83 (4): 359–60. PMID 10575299. Retrieved 2012-02-12.
- ↑ Koshy KM, Griswold E, Schneeberger EE (1999). "Interstitial nephritis in a patient taking creatine". The New England Journal of Medicine. 340 (10): 814–5. doi:10.1056/NEJM199903113401017. PMID 10075534. Retrieved 2012-02-12. Unknown parameter
|month=ignored (help) - ↑ Abadín JA, Durán JA, Pérez de León JA (1998). "Probable diltiazem-induced acute interstitial nephritis". The Annals of Pharmacotherapy. 32 (6): 656–8. PMID 9640485. Retrieved 2012-02-12. Unknown parameter
|month=ignored (help) - ↑ Corrigan G, Stevens PE (2000). "Review article: interstitial nephritis associated with the use of mesalazine in inflammatory bowel disease". Alimentary Pharmacology & Therapeutics. 14 (1): 1–6. PMID 10632639. Retrieved 2012-02-12. Unknown parameter
|month=ignored (help) - ↑ Post AT, Voorhorst G, Zanen AL (2000). "Reversible renal failure after treatment with omeprazole". The Netherlands Journal of Medicine. 57 (2): 58–61. PMID 10924942. Unknown parameter
|month=ignored (help);|access-date=requires|url=(help) - ↑ Markowitz GS, Tartini A, D'Agati VD (1998). "Acute interstitial nephritis following treatment with anorectic agents phentermine and phendimetrazine". Clinical Nephrology. 50 (4): 252–4. PMID 9799071. Unknown parameter
|month=ignored (help);|access-date=requires|url=(help) - ↑ Schurman SJ, Alderman JM, Massanari M, Lacson AG, Perlman SA (1998). "Tubulointerstitial nephritis induced by the leukotriene receptor antagonist pranlukast". Chest. 114 (4): 1220–3. PMID 9792602. Retrieved 2012-02-12. Unknown parameter
|month=ignored (help) - ↑ Fang JT, Huang CC (1998). "Propylthiouracil-induced acute interstitial nephritis with acute renal failure requiring haemodialysis: successful therapy with steroids". Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 13 (3): 757–8. PMID 9550661. Retrieved 2012-02-12. Unknown parameter
|month=ignored (help) - ↑ 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.
- ↑ Neelakantappa K, Gallo GR, Lowenstein J. Ranitidine-associated interstitial nephritis and Fanconi syndrome. Am J Kidney Dis. 1993;22(2):333.
- ↑ Wai AO, Lo AM, Abdo A, Marra F (1998). "Vancomycin-induced acute interstitial nephritis". The Annals of Pharmacotherapy. 32 (11): 1160–4. PMID 9825081. Retrieved 2012-02-12. Unknown parameter
|month=ignored (help) - ↑ 15.0 15.1 Rossert J (2001). "Drug-induced acute interstitial nephritis". Kidney Int. 60 (2): 804–17. doi:10.1046/j.1523-1755.2001.060002804.x. PMID 11473672.
- ↑ Pusey C, Saltissi D, Bloodworth L, Rainford D, Christie J (1983). "Drug associated acute interstitial nephritis: clinical and pathological features and the response to high dose steroid therapy". Q J Med. 52 (206): 194–211. PMID 6604293.
- ↑ Handa S (1986). "Drug-induced acute interstitial nephritis: report of 10 cases". CMAJ. 135 (11): 1278–81. PMID 3779558.
- ↑ Buysen J, Houthoff H, Krediet R, Arisz L (1990). "Acute interstitial nephritis: a clinical and morphological study in 27 patients". Nephrol Dial Transplant. 5 (2): 94–9. PMID 2113219.
- ↑ Schwarz A, Krause P, Kunzendorf U, Keller F, Distler A (2000). "The outcome of acute interstitial nephritis risk factors for the transition from acute to chronic interstitial nephritis". Clin Nephrol. 54 (3): 179–90. PMID 11020015.
- ↑ Lins R, Verpooten G, De Clerck D, De Broe M (1986). "Urinary indices in acute interstitial nephritis". Clin Nephrol. 26 (3): 131–3. PMID 3769228.
- ↑ Graham G, Lundy M, Moreno A (1983). "Failure of Gallium-67 scintigraphy to identify reliably noninfectious interstitial nephritis: concise communication". J Nucl Med. 24 (7): 568–70. PMID 6864309.
- ↑ Linton A, Richmond J, Clark W, Lindsay R, Driedger A, Lamki L (1985). "Gallium67 scintigraphy in the diagnosis of acute renal disease". Clin Nephrol. 24 (2): 84–7. PMID 3862487.