acute interstitial nephritis
a·cute in·ter·sti·tial ne·phri·tis
acute interstitial nephritis
Renal inflammation characterised by cellular—primarily mononuclear—and fluid exudates, often with epithelial degeneration.Drug aetiology, acute interstitial nephritis
Antibiotics
• Beta lactams—penicillin, methicillin, ampicillin, amoxicillin, cephalosporines.
• Others—sulfonamides, rifampin, vancomycin, ethambutol, trimethoprim-sulfamathoxazole.
NSAIDs
Indomethacin, ibuprofen, naproxen, mefanamic acid, tolmetin, aspirin, phenylbutazone.
Diuretics
Furosemide, thiazides.
Others
Azathioprine, aldomet, carbamazepine, diphenylhidantoin, phenobarbital.
Findings-hypersensitivity
Fever, rash, sore throat, malaise, arthralgia, myalgia, hepatitis, splenomegaly, eosinophilia, lymphoadenopathy, thrombocytopaenia, autoimmune haemolysis.
Findings-anaphylaxis
Respiratory tract (laryngeal oedema, asthma); skin (urticaria, angioedema); GI tract (nausea and vomiting, diarrhea); cardiovascular (capillary leak, hypotension).
Types
Idiopathic, secondary to drugs (penicillins, ampicillin, sulpha drugs, NSAIDs, furosemide, thiazide diuretics) or infections.
Lab-Proximal tubule
Glycosuria, aminoaciduria, tubular proteinuria (usually < 1 g/24 h), hypouricaemia.
Lab-Distal tubule
Distal renal tubular acidosis, increased K+, isosthenuria, Na+ wasting.
Management
Corticosteroids may be effective.
Prognosis
Ranges from mild renal dysfunction to acute renal failure.