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Acute Interstitial Nephritis

TINU syndrome


Presentation

  • He was put on aspirin following surgery and took ibuprofen for fever for nearly a week prior to presentation.[ncbi.nlm.nih.gov]
  • Using modified Banff scheme criteria, mild tubulitis (t1) was present in 56% of cases, a moderate tubulitis (t2) in 24% of cases, and a severe tubulitis in 20% of cases.[ncbi.nlm.nih.gov]
  • The patient presented with severe epigastric pain, edema of the legs, proteinuria and severe hypoalbuminemia. Gastric and duodenal biopsies found eggs, larval and adult forms present in the superficial mucosa with mild inflammation.[ncbi.nlm.nih.gov]
  • The main case presented here is that of a 73-year-old man with a history of chronic low back pain who presented with worsening back pain, as well as nausea, vomiting and volume depletion.[ncbi.nlm.nih.gov]
  • A 64-year-old female patient presented to the emergency department with a 3-week history of persistent nausea and vomiting. Her serum creatine prior to admission was 118 µmol/L and on presentation was elevated to 420 µmol/L.[ncbi.nlm.nih.gov]
Intravenous Drugs
  • The majority (62%) of patients were on antiretroviral therapy, 59% were current or former intravenous drug users, and 62% had hepatitis C co-infection. Drugs were identified as the cause of AIN in the majority (72%) of cases.[ncbi.nlm.nih.gov]
  • Drug Abuse (IVDA) Radiation Nephritis Idiopathic Interstitial Nephritis Physiology Infection-Associated Acute Interstitial Nephritis : in infections such as Leptospirosis/CMV/ Streptococcus /Legionellosis, detection of organism-specific antigens and[mdnxs.com]
Rigor
  • The patient presented with fever, rigors and dialysis dependent acute kidney injury, just a few days after treatment of a respiratory tract infection with moxifloxacin.[ncbi.nlm.nih.gov]
Lower Abdominal Pain
  • A Caucasian woman aged 43 years presented with a 5-week history of lethargy, left-sided lower abdominal pain, nausea and vomiting. She had been taking phentermine for weight loss for 9 months and had recently ceased the medication.[ncbi.nlm.nih.gov]
Skin Discoloration
  • Phenazopyridine is a urinary analgesic; commonly seen side-effects of this drug include, orange discoloration of urine, methemoglobinemia, yellowish skin discoloration, hepatitis and acute renal failure.[ncbi.nlm.nih.gov]
Morning Stiffness
  • He later developed a symmetric distal polyarthritis with morning stiffness mimicking RA.[ncbi.nlm.nih.gov]

Workup

  • All other workup was negative including urine eosinophils, urine casts, urine culture, urine drug screen, ANA, serum and urine electrophoresis, and renal ultrasound.[shmabstracts.com]
  • General Investigation The patient usually needs a complete workup.[myvmc.com]
  • Renal ultrasound may be ordered as part of the workup for acute renal failure, however, there are no pathognomonic signs for AIN on ultrasound. F. Over-utilized or “wasted” diagnostic tests associated with this diagnosis.[clinicaladvisor.com]
Gram-Positive Bacteria
  • Linezolid is a recent addition to the antibiotic armamentarium against Gram-positive bacteria, including multiresistant staphylococci and enterococci. Linezolid is relatively well tolerated and is not believed to be nephrotoxic.[ncbi.nlm.nih.gov]
Plasmodium Falciparum
  • A blood film was positive for Plasmodium falciparum. His creatinine was 616 µmol/L coming from a normal baseline of 89 µmol/L. He had a urine protein:creatinine ratio of 346 mg/mmol (4.4 g/L). He required dialysis.[ncbi.nlm.nih.gov]

Treatment

  • There are no established criteria for the administration of corticosteroids in the treatment of drug-induced AIN.[ncbi.nlm.nih.gov]
  • Severe allergic reactions from bortezomib treatment including AIN have not been described in the literature. We report a 47-year-old white man who developed biopsy-proven allergic AIN after treatment with bortezomib for his C3 glomerulonephritis.[ncbi.nlm.nih.gov]
  • Fifteen days prior to presentation, she had started treatment with intramuscular cefoperazone 1 g/day for a scalp infection.[ncbi.nlm.nih.gov]
  • Abstract Telithromycin, a ketolide antibiotic used for the treatment of community-acquired respiratory infections, is widely prescribed in primary care practice.[ncbi.nlm.nih.gov]
  • Cefepime therapy was ceased and treatment with ciprofloxacin was given to complete the treatment course. Renal function improved only partially with conservative management without any corticosteroid use.[ncbi.nlm.nih.gov]

Prognosis

  • Prognosis of benign renal glycosuria is excellent and reversible. Acute interstitial nephritis (AIN) is one of the main causes of acute renal failure and may often result in tubular dysfunction.[ncbi.nlm.nih.gov]
  • In general, the prognosis for drug-induced AIN is good, and at least partial recovery of kidney function is normally observed. Early recognition is crucial because patients can ultimately develop chronic kidney disease.[ncbi.nlm.nih.gov]
  • Prognosis The overall prognosis for AIN is excellent. Most patients’ renal function recovers upon cessation of the offending agent. The improvement occurs within 6-8 weeks.[myvmc.com]
  • Features of interstitial fibrosis may be seen within 7-10 days and may be accompanied by tubular atrophy and portend a POOR prognosis with the development of variable degrees of CKD Immunofluorescence 1. Often negative 2.[renalandurologynews.com]
  • NSAIDs) P enicillins and cephalosporins P roton pump inhibitors rifam P in systemic infections mycoplasma autoimmune diseases systemic lupus erythematosus sarcoidosis Pathogenesis type IV hypersensitivity reaction T-cell-mediated attack on tubular cells Prognosis[medbullets.com]

Etiology

  • Many etiologies of AIN have been recognized--including allergic/drug-induced, infectious, autoimmune/systemic, and idiopathic forms of disease. The most common etiology of AIN is drug-induced disease, which is thought to underlie 60-70% of cases.[ncbi.nlm.nih.gov]
  • While the most common etiology being drug-induced, other causes are infectious, autoimmune, and idiopathic forms of disease.[ncbi.nlm.nih.gov]
  • Etiologically, renal glycosuria is of 3 types-benign renal glycosuria, glycosuria with diabetes mellitus (including gestational diabetes) and tubular defects (Fanconi syndrome). Prognosis of benign renal glycosuria is excellent and reversible.[ncbi.nlm.nih.gov]
  • A careful medication history and renal biopsy were essential in identifying the etiology of the acute kidney injury in this patient with a complex renal history.[ncbi.nlm.nih.gov]
  • By and large, drug-induced AIN is currently the commonest etiology of AIN, with antimicrobials and nonsteroidal anti-inflammatory drugs being the most frequent offending agents.[ncbi.nlm.nih.gov]

Epidemiology

  • Acute interstitial nephritis (AIN) is an important cause of acute kidney injury that has experienced significant epidemiological and clinical changes in the last years.[ncbi.nlm.nih.gov]
  • Epidemiology Relative Frequencies of Etiologies Drugs : account for 70-75% of acute interstitial nephritis cases Antibiotics : account for 30-49% of drug-associated acute interstitial nephritis cases Infections : account for 4-10% of acute interstitial[mdnxs.com]
  • Introduction Clinical definition acute interstitial nephritis (AIN), also known as tubulointerstitial nephritis, is an acute immune-mediated interstitial inflammation of the kidneys Epidemiology demographics male:female ratio is 3:1 in methicillin-induced[medbullets.com]
  • Vijayakumar Drugs & Therapy Perspectives (2018) Tubulointerstitial nephritis and uveitis (TINU) syndrome: a systematic review of its epidemiology, demographics and risk factors Linda O. Okafor, Peter Hewins, Philip I. Murray & Alastair K.[nature.com]
  • […] and BK Virus HIV Salmonella species, Mycobacterium TB, EBV and Toxoplasmosis May cause granulomatous interstitial nephritis Idiopathic: Tubulointerstitial Nephritis with Uveitis (TINU), 1st described by Dobrin et al, American Journal of Medicine, 1975 Epidemiology[renalandurologynews.com]
Sex distribution
Age distribution

Pathophysiology

  • The pathophysiologic causes, however, are varied.[ncbi.nlm.nih.gov]
  • DISCUSSION: The pathophysiology of TINU Syndrome remains poorly understood, probably involving both cellular and humoral immunity.[bjn.org.br]
  • Tubulointerstitial diseases of the kidney encompass diverse etiologies and pathophysiologic processes, and the patient can present with acute or chronic conditions.[emedicine.medscape.com]
  • Tubulointerstitial nephritis encompass diverse etiologies and pathophysiologic processes, and the patient can present with acute or chronic disease.[kidneypathology.com]

Prevention

  • A 68-year-old woman was scheduled to undergo percutaneous embolization of a pulmonary arteriovenous malformation (PAVM) to prevent a paradoxical embolic event.[ncbi.nlm.nih.gov]
  • Early use of steroid therapy may hasten renal recovery by preventing the development of interstitial fibrosis.[ncbi.nlm.nih.gov]
  • , can’t be prevented.[medanta.org]
  • It is important for health professionals to be aware of this adverse drug reaction, because an accurate and timely diagnosis and withdrawal of the offending drug can prevent potentially life-threatening renal failure.[ncbi.nlm.nih.gov]
  • Early detection of this rare adverse reaction is paramount in order to prevent acute renal insufficiency.[ncbi.nlm.nih.gov]

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