Acute tubulointerstitial nephritis atin is a common cause of acute kidney injury aki, early treatment of which improves prognosis. Many classes of drugs may induce interstitial nephritis including newer chemotherapeutic agents, anticoagulants, antidepressants, and others. Estimates indicate that ain is the primary finding on 25% of all native kidney biopsies. Dec 07, 2017 drug induced acute interstitial nephritis diain is a common cause of aki, affecting about 20% of patients with unexplained aki, and leads to ckd and esrd. The majority of patients with ain have complete or partial renal recovery even when severe.
Acute interstitial nephritis ain is a common cause of acute kidney injury. The most common etiology of ain is drug induced disease, which results from a reaction to certain medications. A clinicopathological study and comparative trial of steroid regimens r ramachandran 1, k kumar 1, r nada 2, v jha 1, kl gupta 1, hs kohli 1 1 department of nephrology, pgimer, chandigarh, india 2 department of histopathology, pgimer, chandigarh, india. More than 250 drugs carry a small but important doseindependent risk of initiating a delayedtype hypersensitivity reaction that leads to acute tubulointerstitial nephritis tin. Published causes of ain are diverse and may be grouped into drugs, infections, systemic diseases, malignancies, and idiopathic forms. Druginduced acute interstitial nephritis basicmedical key.
Less frequently, ain is secondary to infection or sarcoidosis. Other general symptoms that occur with variable frequency include nausea, vomiting, fatigue, lack of appetite, and weight loss. Pantoprazoleinduced acute interstitial nephritis cmaj. Druginduced acute interstitial nephritis american society. Using the search terms acute interstitial nephritis and acute tubulointerstitial nephritis, a comprehensive listing of over 250 drugs were identified as causing druginduced ain.
In severe cases, if cessation of the offending drug is not followed by a prompt improvement in renal function. Patients with ain typically present with nonspecific symptoms. Early steroid treatment improves the recovery of renal function in patients with druginduced acute interstitial nephritis. Many etiologies of ain have been recognizedincluding allergicdruginduced, infectious, autoimmunesystemic, and. Drug associated acute interstitial nephritis ain is characterized by acute or sub acute loss of kidney function, interstitial infiltrates, edema, and tubulitis on kidney biopsy, with a relative sparing of the glomerulus and vasculature1. Acute interstitial nephritis ain represents a frequent cause of acute kidney injury, accounting for 1527% of renal biopsies performed because of this condition. Acute interstitial nephritis ain may account for up to 10%25% of patients undergoing renal biopsy for unexplained or drug induced aki, respectively. Over fifty medications have been reported to cause ain, but the overall drug specific incidence still remains low. Pdf steroid treatment of druginduced acute interstitial. It is now well recognized as a common cause of acute kidney. Druginduced kidney diseases np singh, a ganguli, a prakash abstract druginduced kidney disease constitutes an important cause of acute renal failure and chronic kidney disease in present day clinical practice. Duration of treatment with corticosteroids and recovery of. Druginduced crystalluria drug insoluble in urine and crystallizes in distal tubule. Druginduced acute interstitial nephritis neeraja kambham, md key facts terminology acute tubulointerstitial inflammation due to allergic reaction to a drug etiologypathogenesis tcellmediated hypersensitivity reaction idiosyncratic reaction, not dose dependent clinical issues triad of fever, rash, eosinophilia in acute interstitial nephritis represents an emerging cause of acute kidney disease, especially among polymedicated elderly patients.
Pdf druginduced acute interstitial nephritis researchgate. A 42yearold man was referred to a department of respiratory medicine because of persistent cough, anorexia, and asthenia. Keywords druginduced lupus erythematosus, systemic lupus erythematosus, amiodarone, chlorthalidone, acute interstitial nephritis. Acute interstitial nephritis renal and urology news. Drug induced acute interstitial nephritis efstathios alexopoulos, md depnrtmerit of nqihrology hippokrntion geiirrnl hosp fnl thrssnlornki, greece abstract acufe interstitial nephritis cuv is a forni of inflaniniatow renal dis ease afecting predoniinantly the tubules and the interstitiuni. Diagnosis of diain is obvious when the classic triad of rash, fever. Drug induced acute interstitial nephritis dain is a common cause of acute kidney injury and often presents as an unexplained rise in serum creatinine level. Eosinophiluria and drug induced acute interstitial nephritis. Importantly, ain should not be overlooked because it usually requires specific therapeutic intervention. Druginduced acute interstitial nephritis request pdf. Steroid treatment of drug induced acute interstitial nephritis. Druginduced acute interstitial nephritis and vasculitis. By and large, druginduced ain is currently the commonest etiology of ain, with antimicrobials and nonsteroidal antiinflammatory drugs being the most frequent offending agents. Druginduced acute interstitial nephritis diain is a common cause of aki, affecting about 20% of patients with unexplained aki, and leads to ckd and esrd 11.
Interstitial nephritis is a kidney disorder in which the kidneys ability to filter waste and extra fluids is impaired. Druginduced acute tubulointerstitial nephritis oxford medicine. Several drugs have been associated with the development of ain, including antibiotics and nonsteroidal antiinflammatory agents, all with characteristic. Different classes of drugs, by virtue of immunological mechanisms. Antibiotics, proton pump inhibitors and nonsteroidal antiinflammatory drugs are common causes.
Acute interstitial nephritis ain vs acute tubular necrosis atn diganosis renal biopsy gold standard history, exam, lab, urine. Although any drug can potentially cause diain, antibiotics, nonsteroidal antiinflammatory drugs, and proton pump inhibitors, are the most frequent offenders. Acute interstitial nephritis aetiology bmj best practice. Medicationinduced interstitial nephritis in the 21st century. Clinical manifestations are often nonspecific, making epidemiological studies challenging. Acute interstitial nephritis and druginduced systemic lupus. Involvement of drugspecific t cells in acute druginduced interstitial nephritis. Although any drug can potentially cause diain, antibiotics, nonsteroidal antiinflammatory drugs, and proton pump inhibitors, are. We report the first case of phentermine induced ain. Drugassociated acute interstitial nephritis ain is characterized by acute or sub acute loss of kidney function, interstitial infiltrates, edema, and tubulitis on kidney biopsy, with a relative sparing of the glomerulus and vasculature1. Acute interstitial nephritis ain is a form of inflammatory renal disease affecting predominantly the tubules and the interstitium.
Treatment of acute interstitial nephritis uptodate. Phentermine induced acute interstitial nephritis bmj. In our patients case, confounding factors delayed diagnosis. Acute interstitial nephritis a reappraisal and update. Druginduced acute interstitial nephritis efstathios alexopoulos, md depnrtmerit of nqihrology hippokrntion geiirrnl hosp fnl thrssnlornki, greece abstract acufe interstitial nephritis cuv is a forni of inflaniniatow renal dis ease afecting predoniinantly the tubules and the interstitiuni. Many etiologies of ain have been recognizedincluding. Many etiologies of ain have been recognizedincluding allergic druginduced, infectious, autoimmunesystemic, and idiopathic forms of disease. Acute interstitial nephritis ain is characterized by the presence of an inflammatory cell infiltrate in the interstitium of the kidney. Acute tubulointerstitial nephritis ain is a common cause of aki and acute kidney disease, and it is noted to be the diagnosis in up to 20% of. The most common etiology of ain is druginduced disease, which results from. Ain can lead to acute renal failure and it is estimated that ain may be the cause in up to 15% of patients hospitalized for acute renal failure. May, 2019 the outcome of acute interstitial nephritis. Acute interstitial nephritis ain is most often induced by drug therapy, although sar coidosis.
Over twothirds of acute interstitial nephritis cases are druginduced. Druginduced acute interstitial nephritis diain is a common cause of aki, affecting about 20% of patients with unexplained aki, and leads to ckd and esrd. Acute interstitial nephritis american journal of kidney. The mononuclear inflammatory infiltrate contains abundant eosinophils. Interstitial nephritis may present with a variety of signs and symptoms, many of these nonspecific. Introduction acute interstitial nephritis ain is a renal lesion that typically causes a decline in renal function and is characterized by an inflammatory infiltrate in the kidney interstitium. Inadequate drug prescription and the rise in druginduced. Acute interstitial nephritis symptoms, diagnosis and. Acute renal failure induced by acute interstitial nephritis secondary. In a study of 81 patients with acute renal failure who had a renal biopsy, signs of hypersensitivity were found in 14% of patients with druginduced acute tubular necrosis 40 x 40. Interstitial nephritis, druginduced, acute kidney injury, drug hypersensitivity reaction introduction the. Druginduced acute interstitial nephritis principal discussant. Acute interstitial nephritis ain is a pattern of acute kidney inflammation, localised to the kidney tubulo interstitial space and usually triggered by medications.
About 15% of biopsies for acute renal failure arf show that it is caused by druginduced acute interstitial nephritis diatin, mostly immunoallergic. Druginduced acute interstitial nephritis and vasculitis or vasculary rejection in renal allografts sait s. Pdf acute interstitial nephritis ain is a common cause of acute kidney injury. Acute interstitial nephritis and druginduced systemic.
Acute interstitial nephritis ain is a frequent cause of acute kidney injury aki. We report a patient who developed acute kidney injury, rash, and druginduced systemic lupus diagnosed by serologies after starting chlorthalidone and amiodarone. Druginduced acute interstitial nephritis diain is a common cause of aki, affecting about 20% of. Druginduced acute interstitial nephritis diain is a common cause of aki, affecting about 20% of patients with unexplained aki, and leads to. Druginduced acute interstitial nephritis and vasculitis or. Changes in the aetiology, clinical presentation and management of acute interstitial nephritis, an increasingly common cause of acute kidney. The incidence of druginduced interstitial nephritis is increasing, particularly in the elderly. Background and objectives drug induced acute interstitial nephritis represents an emerging cause of acute kidney disease, especially among polymedicated elderly patients. It can be difficult for clinicians to differentiate between ain and other common causes of aki, most notably acute tubular necrosis atn and prerenal injury. Acute interstitial nephritis occurs due to dnadrug or proteindrug complexes that trigger an allergic immune response. It accounts for approximately % of all cases of acute renal failure arf and. Jun 15, 2003 acute interstitial nephritis is an important cause of acute renal failure resulting from immunemediated tubulointerstitial injury, initiated by medications, infection, and other causes. Drug hypersensitivity is the most common etiology and the list of drugs that can induce ain is not exhaustive yet.
Next, each drug was investigated using pubmed and fda registries for its mechanism of. Steroid treatment of druginduced acute interstitial nephritis. Phentermine induced acute interstitial nephritis bmj case. Acute interstitial nephritis ain, which is primarily drug. Diagnosis and management of acute interstitial nephritis american. Jul 07, 2009 acute interstitial nephritis ain is a form of inflammatory renal disease affecting predominantly the tubules and the interstitium. Acute interstitial nephritis ain may be seen especially. Aug 29, 20 tubulitis infiltration of tubules by lymphocytes. Phentermine is a rare cause of druginduced acute interstitial nephritis ain. The most common etiology of ain is druginduced disease. Fig 1 in acute interstitial nephritis, there is edema associated with an interstitial lymphoplasmocytic infiltrate.
Acute interstitial nephritis ain may account for up to 10%25% of patients undergoing renal biopsy for unexplained or druginduced aki, respectively. Fever is the most common, occurring in 3050% of patients, particularly those with druginduced interstitial nephritis. Drugassociated acute interstitial nephritis ain is characterized by acute or subacute loss of kidney function, interstitial infiltrates, edema, and tubulitis on kidney biopsy, with a relative sparing of the glomerulus and vasculature 1. Druginduced acute interstitial nephritis american society of. Drug induced acute interstitial nephritis drugs, particularly antibiotics, are the most common etiology of ain. Mechanisms of druginduced interstitial nephritis sciencedirect. Pantoprazoleinduced acute interstitial nephritis is an increasingly known complication of proton pump inhibitor therapy. Estimates indicate that ain is the primary finding in 2%5% of all native kidney biopsies. Druginduced acute renal dysfunction karen shalansky, pharm. Drug induced acute interstitial nephritis diain is a common cause of aki, affecting about 20% of patients with unexplained aki, and leads to ckd and esrd 11.
Acute interstitial nephritis ain has a number of medicationrelated aetiologies. Glomeruli and vessels typically appear normal in acute in. Acute interstitial nephritis ain classically presents as acute kidney injury aki after the use of known offending drugs and is sometimes associated with the urinary findings of pyuria, hematuria, and white cell casts. When to use steroid treatment for those patients with druginduced. There are numerous causes for acute interstitial nephritis, including toxins, infections especially viral, and most commonly in renal biopsy practice, druginduced hypersensitivity reactions. Diagnosis and management of acute interstitial nephritis. Although acute interstitial nephritis usually appears in the early phase, his is a rare case of acute interstitial nephritis more than 2 years after the onset of. Druginduced acute interstitial nephritis diain occurs in 0.
Over fifty medications have been reported to cause ain, but the overall drugspecific incidence still remains low. Druginduced acute interstitial nephritis with nifedipine leonardgolbin, 1 thibaultdolleyhitze, 1 nolwennlorcy, 1 nathalieriouxleclercq, 2,3 andcecilevigneau 1,2 chuderennes,serviceden. Moledina and others published druginduced acute interstitial nephritis find, read and cite all the research you need on researchgate. Drug induced acute interstitial nephritis neeraja kambham, md key facts terminology acute tubulointerstitial inflammation due to allergic reaction to a drug etiologypathogenesis tcellmediated hypersensitivity reaction idiosyncratic reaction, not dose dependent clinical issues triad of fever, rash, eosinophilia in jul 17, 2007 acute interstitial nephritis ain is characterized by the presence of an inflammatory cell infiltrate in the interstitium of the kidney. The hallmark pathologic features of dain are interstitial edema, interstitial inflammation, and tubulitis. Pdf druginduced acute interstitial nephritis pathology. Druginduced acute interstitial nephritis kidney international. Although any drug can potentially cause diain, antibiotics, nonsteroidal antiinflammatory drugs, and proton pump inhibitors, are the most frequent offenders 1. In a study of 81 patients with acute renal failure who had a renal biopsy, signs of hypersensitivity were found in 14% of patients with drug induced acute tubular necrosis 40 x 40. Evaluation of clinical and histological prognostic markers in drug induced acute interstitial nephritis. Drug induced acute interstitial nephritis diain is a drug hypersensitivity reaction dhr that manifests 7 to 10 days after exposure to the culprit drug.
Druginduced acute interstitial nephritis with nifedipine. Early recognition and appropriate therapy are essential to its management. A caucasian woman aged 43 years presented with a 5week history of lethargy, leftsided lower. Clinical manifestations and diagnosis of acute interstitial. Acute interstitial nephritis ain is a common cause of acute kidney injury aki, particularly in hospitalized patients. Treatment of druginduced acute tubulointerstitial nephritis. Antibiotics, nonsteroidal antiinflammatory drugs and proton pump inhibitors are most frequently associated with druginduced acute interstitial nephritis. Although corticosteroids are frequently used, controversy exists about the timing of initiation, efficacy, safety, and duration of treatment. Management of drugassociated acute interstitial nephritis. Acute interstitial nephritis is an important cause of acute kidney injury. The mainstay of treatment in ain removal of the offending agent and though evidence is mixed, steroid therapy should also be considered.
Dhrs account for fewer than 15% of reported adverse drug reactions. Eosinophiluria and druginduced acute interstitial nephritis. Kidney biopsy is therefore frequently required to make a definitive diagnosis. Druginduced acute tubulointerstitial nephritis atin is the most common aetiology of atin and a potentially correctable cause of acute kidney injury aki.
Tubulointerstitial nephritis and uveitis syndrome tinudobrin syndrome. Many etiologies of ain have been recognizedincluding allergic drug induced, infectious, autoimmunesystemic, and. Acute interstitial nephritis is an important cause of acute renal failure resulting from immunemediated tubulointerstitial injury, initiated by medications. Druginduced acute interstitial nephritis diain represents a high percentage of acute renal failure in clinical practice. Diagnosis of diain is obvious when the classic triad of rash, fever, and eosinophilia occur within a few days of the initiation of a culprit drug. Druginduced acute interstitial nephritis dain is a common cause of acute kidney injury and often presents as an unexplained rise in serum creatinine level. Druginduced acute interstitial nephritis drugs, particularly antibiotics, are the most common etiology of ain. The condition may be temporary, acute, or if it persists for a long period of time, it. Drugs are implicated in 70%90% of biopsyproved in with a prevalence of 50% in less developed to 78% in more developed countries. Case report druginduced acute interstitial nephritis with.
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