Acute Interstitial Nephritis

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Contents 1 More Specific Terms 2 Etiology 3 Pathology 4 Clinical-manifestations 5 Laboratory 6 Radiology 7 Management 8 More General Terms 9 Additional Terms 10 References

More Specific Terms

• acute uric acid nephropathy

Etiology

• allergic reaction
• pharmacologic causes (most common)

• antibiotics

• penicillins, esp methicillin (anti-tubular basement membrane antibodies)
• cephalosporins
• anti- tuberculous medications

• rifampin
• isoniazid
• ethambutol

• sulfonamides
• fluoroquinolones

• ciprofloxacin
• levofloxacin

• pentamidine

• antiviral: indinavir
• NSAIDs (large doses), COX2 inhibitors
• diuretics (sulfa derivatives)

• thiazides
• furosemide ( Lasix)
• bumetanide ( Bumex)

• cimetidine
• proton pump inhibitors
• allopurinol, phenytoin & phenindione cause

• exfoliative dermatitis
• hepatitis
• acute interstitial nephritis

• cyclosporin A - acute renal vasoconstriction
• phenobarbital
• interferon alpha

• infection

• streptococcus
• leptospirosis
• Rocky Mountain spotted fever
• Legionella
• Epstein Barr virus
• cytomegalovirus
• HIV
• toxoplasmosis
• polyoma BK virus in renal transplant patients

• infiltrative malignancies

• lymphoma
• leukemic infiltration

• autoimmune

• lupus nephritis
• Sjogren's syndrome
• sarcoidosis

• toxins

• Chinese herp nephropathy
• heavy metal toxicity
• myeloma cast nephropathy

• renal transplant rejection
• radiation
• acute pyelonephritis

Pathology

• acute interstitial infiltrate

• mononuclear cells
• eosinophils (less frequently)

Clinical-manifestations

• fever 90% 2 weeks duration
• arthralgias (25%)
• rash (25%)
• acute renal failure is generally non- oliguric

Laboratory

• urinalysis:

• sterile pyuria (100%)
• hematuria (95%), no RBC casts
• proteinuria (75%)

• < 2.5 mg/mg of creatinine (not nephrotic range)

• urinary leukocyte casts in the urine sediment
• eosinophiluria (50%)

• renal insufficiency (60%)

• increased serum creatinine
• serum urea nitrogen

• renal biopsy sometimes needed for diagnosis

Radiology

• renal ultrasound may show renal papillary necrosis
• gallium scan or indium scan can be helpful

Management

• discontinue use of offending pharmaceutical agent
• prednisone 60 mg QOD for 2-4 weeks [4,6]

• improves recovery, diminishes need for dialysis [6]

• specific therapy for specific etiology
• dialysis may be necessary
• recovery is variable

More General Terms

• interstitial nephritis
• acute inflammation

Additional Terms

• chronic interstitial nephritis (analgesic nephropathy, drug-induced chronic interstitial nephritis)

References

1. Harrison's Principles of Internal Medicine, 13th ed. Companion Handbook, Isselbacher et al (eds), McGraw-Hill Inc. NY, 1995, pg 829-39
2. Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 266
3. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 612
4. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15 American College of Physicians, Philadelphia 1998, 2006, 2009
5. Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004
6. Gonzalez E et al Early steroid treatment improves the recovery of renal function in patients with drug-induced acute interstitial nephritis. Kidney Int. 2008 Apr;73(8):940-6. Epub 2008 Jan 9. PMID: [1]

acute interstitial nephritis