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Allergic Interstitial Nephritis


Presentation

  • We present a 48-year-old man who was on warfarin sodium for 2 months and presented with acute renal failure and reddish purplish macules on his hypogastric regions and lower extremities bilaterally.[ncbi.nlm.nih.gov]
  • Footnotes The section Cases presents brief case reports that convey clear, practical lessons. Preference is given to common presentations of important rare conditions, and important unusual presentations of common problems.[cmaj.ca]
  • We present a rare case of a pediatric patient with mesalazine-induced interstitial nephritis whose initial presentation with clinical and radiologic signs of pyelonephritis complicated the decision to undergo renal biopsy.[journals.lww.com]
  • A 69-year-old female patient with a history of metastatic renal cell carcinoma after left radical nephrectomy presented to our nephrology clinic after completing 2 courses of sunitinib therapy.[ncbi.nlm.nih.gov]
  • Presented in part at the Fifth International Congress of Nephrology, Mexico City, Mexico, October, 1972.[nejm.org]
Fever
  • Initial symptoms included fever, eosinophilia, low albuminuria, microscopic hematuria, eosinophiluria and acute renal failure. Kidney biopsy showed severe interstitial nephritis with interstitial edema, inflammatory infiltrates and tubulorrhexis.[ncbi.nlm.nih.gov]
  • Mesalazine therapy was stopped with immediate resolution of fever.[journals.lww.com]
  • Definition / general Drug reaction to beta lactam antibiotics, non-steroidal anti-inflammatory drugs, diuretics, other drugs; generally after 2 – 3 weeks after exposure May occur in renal allografts ( Clin Nephrol 2009;72:331 ) Fever, hematuria, azotemia[pathologyoutlines.com]
  • : meghana jadhav Forum Elite Topics: 80 Posts: 304 Feb 09, 2005 - 8:43 AM #4 ACUTE ALLERGIC INTERSTITIAL NEPHRITIS IS ALLERGIC...TYPE1 YPE OF SENSITIVITY REACTON .......AS EOSINOPHILIS RASH AND FEVER R CHARE...FEATURES md2besoon Forum Elite Topics: 33[prep4usmle.com]
  • Practice CMAJ March 03, 2009 180 (5) 535-538; DOI: The case: A 57-year-old man presented to hospital with a 2-week history of progressive malaise, myalgia, fever, nausea, vomiting, diarrhea, polyuria and polydipsia.[cmaj.ca]
Malaise
  • Practice CMAJ March 03, 2009 180 (5) 535-538; DOI: The case: A 57-year-old man presented to hospital with a 2-week history of progressive malaise, myalgia, fever, nausea, vomiting, diarrhea, polyuria and polydipsia.[cmaj.ca]
  • […] cause of drug induced AIN Antibiotics: Penicillins [Methicillin classic cause], but Cephalosporins, Sulfonamides [Trimethoprim-Sulfamethoxasole], Rifampin and Quinolones [Ciprofloxacin] Rifampin may be associated with: hemolysis, thrombocytopenia and malaise[renalandurologynews.com]
  • Clinical Features Clinical suspicion of AIN in patients with AKI usually relies on: 2 the presence of general symptoms test malaise anorexia nausea arthralgia hypersensitivity reactions low grade fever skin rash eosinophilia urinalysis findings typical[medsafe.govt.nz]
  • History Part I: Pattern Recognition: Systemic symptoms of allergic interstitial nephritis may include fever, nausea and malaise. The classic triad of fever, rash and eosinophilia is seen in less than 10% of cases.[clinicaladvisor.com]
  • There may be slight malaise, but often the only indication of the disease is the presence of albumin and other abnormal substances in the urine. If a blood count is made during this stage, anemia may be found.[medical-dictionary.thefreedictionary.com]
Fatigue
  • Despite common nonspecific signs and symptoms—fever, fatigue, weight loss, rash, abdominal pain, nausea, vomiting, and diarrhea—laboratory testing and radiology is inconsistent.[journals.lww.com]
  • Clinical characteristics The clinical presentation of acute interstitial nephritis can vary; however, patients typically present with general symptoms of renal failure, such as nausea, vomiting and fatigue.[cmaj.ca]
  • These symptoms may include: Enlarged kidneys Bloody or cloudy urine Fever Rash Fatigue or unusual sleepiness Abdominal pain Increased or decreased urine output Swelling in the body Fluid retention And more Treatment & Prognosis Patients with nephritis[schmidtlaw.com]
  • Gradually renal failure, nausea, vomiting, weight loss, fatigue, and anemia develop. Acidosis and hyperkalemia may follow.[medical-dictionary.thefreedictionary.com]
  • Other symptoms of interstitial nephritis include: a fever blood in the urine exhaustion confusion fatigue nausea vomiting a rash water retention swelling weight gain from water retention feeling bloated elevated blood pressure Acute interstitial nephritis[healthline.com]
Constitutional Symptom
  • symptoms and uveitis HIV-associated renal disease AIDS nephropathy, drug-induced AIN, proteinuria, other renal disorders The Authors show all author info CHARLES M.[aafp.org]
Hemoptysis
  • Considerations 601 Approach to Patients With Systemic Infection 612 Epidemiology and Infection Control 621 PULIMONARY AND CRITICAL CARE 629 Respiratory Therapy Techniques and Mechanical 636 Management of Acute Respiratory Failure 647 Approach to the Patient With Hemoptysis[books.google.de]
Hypertension
  • Highlights include completely updated information on the role of the kidney in hypertension, afferent and efferent mechanisms of renal sodium retention, and delineation of mutation defects causing congenital nephrogenic diabetes insipidus.[books.google.de]
  • Radiation This may occur 6-12 months after radiotherapy, with hypertension, anaemia and oedema. 50% progress to chronic kidney disease. Alternatively, it may develop over several years - presenting with hypertension and proteinuria sometimes.[patient.info]
  • Injury to the medulla can inhibit the ability to concentrate urine, leading to polyuria and polydipsia. 2 Hypertension and edema are not typical features; these signs can help distinguish acute interstitial nephritis from a vascular or glomerular problem[cmaj.ca]
  • D. 3 1 Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, PA, USA; 2 Department of Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA; 3 Division of Nephrology and Hypertension, Department of Medicine[minervamedica.it]
  • . • Hypertension. • Renal vein thrombosis. • Radiation nephritis. • Hereditary nephropathy associated with hyperuricemia and gout. • Idiopathic. 22.[slideshare.net]
Pericardial Friction Rub
  • His chest sounds were normal, and there was no pericardial friction rub or peripheral edema. The results of a dermatological examination were unremarkable. The results of laboratory tests are listed in Table 1 .[cmaj.ca]
Back Pain
  • She did however report a remarkable increase in lower back pain that she had attributed to strenuous exercise.[ijponline.biomedcentral.com]
  • An attack may produce no symptoms, but more often there are headaches, a rundown feeling, back pain, and perhaps slight fever. The urine may look smoky, bloody, or wine-colored.[medical-dictionary.thefreedictionary.com]
  • They admit long-term analgesic use for chronic headaches, low back pain or somatic complaints such as malaise and weakness. They may also have a history of peptic ulcer disease or symptoms. Investigations FBC. U&Es. Urinalysis.[patient.info]
  • 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.[en.wikipedia.org]
Mononeuropathy
  • […] a Sleep 806 Approach to the Patient With Visual 815 Approach to the Patient With Suspected Infection 823 Demyelinating Diseases 832 Chronic Dementing Conditions 835 Central Nervous System Poisoning 841 Disorders of the Peripheral Nervous System 847 Mononeuropathies[books.google.de]
Hematuria
  • Initial symptoms included fever, eosinophilia, low albuminuria, microscopic hematuria, eosinophiluria and acute renal failure. Kidney biopsy showed severe interstitial nephritis with interstitial edema, inflammatory infiltrates and tubulorrhexis.[ncbi.nlm.nih.gov]
  • […] and eosinophilia Variable skin rash May be associated with inactive cytochrome P450 polymorphisms ( Ren Fail 2009;31:749 ) Urinalysis: suggestive of infection (eosinophils, hematuria, proteinuria, pyuria), but culture negative Microscopic (histologic[pathologyoutlines.com]
  • He denied dysuria, hematuria, or changes in his urinary frequency except for withholding of urine, and his urinalysis and cultures were negative.[journals.lww.com]
  • […] diseases systemic lupus erythematosus sarcoidosis Pathogenesis type IV hypersensitivity reaction T-cell-mediated attack on tubular cells Prognosis typically resolves after withdrawal of inciting agent Presentation Symptoms primary symptoms fever minimal hematuria[medbullets.com]
  • Typical symptoms in both acute and chronic nephritis are painless hematuria (without RBC casts !) and pyuria.[amboss.com]
Flank Pain
  • A 13-year-old boy with active Crohn disease and medical history of asthma and attention deficit disorder presented with 1-week history of persistent fever, worsening abdominal and flank pain, diarrhea, and lower extremity myalgias.[journals.lww.com]
  • Drugs with low urine solubility precipitate within the renal tubules tubular obstruction & toxicity to tubules Symptoms Painless hematuria Flank pain Sterile pyuria Peripheral eosinophilia Rash Fever Arthralgias Patients are usually asymptomatic Renal[amboss.com]
  • Signs and symptoms include fever, chills, flank pain, painful and frequent urination, cloudy or bloody urine, and confusion. Diffuse or local inflammation and edema of the interstitial tissue of the kidney, including the tubules.[icd10data.com]
  • […] systemic lupus erythematosus sarcoidosis Pathogenesis type IV hypersensitivity reaction T-cell-mediated attack on tubular cells Prognosis typically resolves after withdrawal of inciting agent Presentation Symptoms primary symptoms fever minimal hematuria flank[medbullets.com]
  • Mostly there are no symptoms directly from the urinary tract, but there may be flank pain and haematuria. Diagnosis is suggested by: Patients aged 30-70 years.[patient.info]
Oliguria
  • Fractional Excretion of Sodium (FENa) may be useful if oliguria 7. CLOSE monitoring of DAILY AM weights and STRICT Intake and Output records each 24hrs Imaging Studies 1.[renalandurologynews.com]
  • A nephrologist should always be consulted in severe cases (robust increases of creatinine value, robust proteinurie, oliguria or anuria, increases in body weight) for further diagnosis and therapy.[thieme-connect.com]
  • . • Eosinophilia, oliguria, glucosuria, aminoaciduria, phosphaturia, raised urinary creatinine, renal acidosis and proteinuria. 63. • Interstitial oedema, mononuclear inflammatory infiltrate consisting of lymphocytes and macrophages. • Eosinophils and[slideshare.net]
  • Clinical Presentation: Often MULTIFACTORIAL cause and co-existence of conditions Associated and symptoms (Ayus al, Medicine, 1982) Fevers and chills Flank or Lumbar pain Dysuria Azotemia Oliguria is RARE Urinary findings: Gross hematuria (19%) Pyuria[renalandurologynews.com]
  • Clinical Features Patients with AIN typically present with nonspecific symptoms of acute renal failure, including oliguria, malaise, anorexia, or nausea and vomiting, with acute or subacute onset. 5 The clinical presentation can range from asymptomatic[aafp.org]

Workup

  • 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]
Pyuria
  • Clin Nephrol 2009;72:331 ) Fever, hematuria, azotemia and eosinophilia Variable skin rash May be associated with inactive cytochrome P450 polymorphisms ( Ren Fail 2009;31:749 ) Urinalysis: suggestive of infection (eosinophils, hematuria, proteinuria, pyuria[pathologyoutlines.com]
  • He received ceftriaxone and ciprofloxacin, but repeat urinalysis continued to demonstrate sterile pyuria with few eosinophils. Urine cultures were negative.[journals.lww.com]
  • […] and pyuria. Depending on the underlying disease, nephritis may present with additional symptoms such as rash, arthralgias, and fever in the case of allergic interstitial nephritis.[amboss.com]
  • (Leukocyturia) Pyuria should be checked PRIOR to testing for eosinophils May be associated with WBC casts CLINICAL PEARL: Pyuria is COMMON ( 80% Methicillin related cases of AIN and 50% in drugs OTHER than Methicillin) Absence of pyuria does NOT rule[renalandurologynews.com]
  • Depending on the extent of tubular involvement, abnormalities in electrolyte levels may be present, the most common of which are hyponatremia and hyperkalemia. 2 Pyuria and proteinuria are almost always present, and hematuria is present in 90% of cases[cmaj.ca]
Albuminuria
  • Initial symptoms included fever, eosinophilia, low albuminuria, microscopic hematuria, eosinophiluria and acute renal failure. Kidney biopsy showed severe interstitial nephritis with interstitial edema, inflammatory infiltrates and tubulorrhexis.[ncbi.nlm.nih.gov]
Creatinine Decreased
  • Arch Pathol Lab Med. 2005 Mar;129(3):e81-3. [ PubMed link ] ) The patient is well, serum creatinine decreased to 1.2 mg/dL 20 days after biopsy. No a specific treatment was done. See the chapter Tubulointerstitial Diseases of our tutorial.[kidneypathology.com]

Treatment

  • Fluindione is a vitamin K antagonist that is commonly prescribed for the treatment of cardiovascular disease and venous thromboembolism in France. Bleeding is the most common side effect of fluindione, whereas hypersensitivity reactions are rare.[ncbi.nlm.nih.gov]
  • Sunitinib is an oral multitargeted inhibitor indicated for the treatment of renal cell carcinoma. This report describes a case of allergic interstitial nephritis possibly related to this agent.[ncbi.nlm.nih.gov]
  • Treatment is initially directed at the systemic disease or removing the offending agent. Steroid therapy may be indicated in cases of acute interstitial nephritis that do not respond to initial treatment.[cmaj.ca]
  • Each chapter begins with normal function and pathophysiology and quickly moves to clinical conditions and treatment. Numerous illustrations, tables, charts, and graphs make complex subjects understandable. Up-to-date references are also included.[books.google.de]
  • Thus, the early detection and causal treatment of acute kidney problems is vitally important for a successful outcome.[books.google.de]

Prognosis

  • Seite 53 - Etiology, incidence, and prognosis of renal failure following cardiac operations. Results of a prospective analysis of 500 consecutive patients. J. thorac. cardiovasc. Surg. ‎ Seite 84 - Rich MW, Crecelius CA.[books.google.de]
  • Acute interstitial nephritis generally has a good prognosis.[amboss.com]
  • 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]
  • In chronic TIN, prognosis depends on the cause and on the ability to recognize and stop the process before irreversible fibrosis occurs.[kidneypathology.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]

Etiology

  • Although a definite etiologic relation has not been established, the diuretic agents employed may have been responsible for the interstitial nephritis in these cases.[nejm.org]
  • Seite 53 - Etiology, incidence, and prognosis of renal failure following cardiac operations. Results of a prospective analysis of 500 consecutive patients. J. thorac. cardiovasc. Surg. ‎ Seite 84 - Rich MW, Crecelius CA.[books.google.de]
  • […] 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 AIN middle-aged adults Etiology[medbullets.com]
  • 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]
  • Codes with this note are Etiology codes and must be followed by a Manifestation code or codes. Code See Section B95-B97, to identify infectious agent. MS-DRG Mapping DRG Group #689-690 - Kidney and urinary tract infections with MCC.[icd.codes]

Epidemiology

  • Written by internationally renowned experts, this clinical reference offers helpful advice with the most recent information on the definition, epidemiology, pathophysiology, and clinical causes of acute kidney failure as a fundamental prerequisite for[books.google.de]
  • Infections in Compromised Hosts 593 Clinical Considerations 601 Approach to Patients With Systemic Infection 612 Epidemiology and Infection Control 621 PULIMONARY AND CRITICAL CARE 629 Respiratory Therapy Techniques and Mechanical 636 Management of Acute[books.google.de]
  • 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]
  • Epidemiology [ edit ] Interstitial nephritis is uncommon ( acute kidney injury of unknown cause. [2] While it can occur in patients of all ages, it is more common in elderly patients, perhaps due to increased exposure to drugs and other triggering causes[en.wikipedia.org]
  • Tubulointerstitial nephritis was identified in nine of 17 biopsies in this study. [9] Balkan endemic nephropathy Epidemiology and natural history clearly implicate environmental factors in the pathophysiology of Balkan endemic nephropathy.[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • This edition has been thoroughly revised by world-renowned contributors to reflect recent developments in renal pathophysiology.[books.google.de]
  • Written by internationally renowned experts, this clinical reference offers helpful advice with the most recent information on the definition, epidemiology, pathophysiology, and clinical causes of acute kidney failure as a fundamental prerequisite for[books.google.de]
  • Allergic interstitial nephritis Crystal-induced acute kidney injury Etiology Antibiotics, NSAIDs, diuretics, allopurinol, PPIs, phenytoin E.g, acyclovir, indinavir, ciprofloxacin, methotrexate Pathophysiology Drugs, particularly antibiotics and NSAIDs[amboss.com]
  • Tubulointerstitial diseases of the kidney encompass diverse etiologies and pathophysiologic processes, and the patient can present with acute or chronic conditions.[emedicine.medscape.com]
  • Pathophysiology of 3 phases • Initiation– tubular cells begin to lose concentrating ability. • Oliguric – tubular epithelium lost, so there is reabsorption of most of the glomerular filtrate. • Diuretic – regenerating epithelium can’t yet concentrate,[slideshare.net]

Prevention

  • Early recognition of this rare complication may prevent the development of severe chronic renal injury.[ncbi.nlm.nih.gov]
  • Written by internationally renowned experts, this clinical reference offers helpful advice with the most recent information on the definition, epidemiology, pathophysiology, and clinical causes of acute kidney failure as a fundamental prerequisite for prevention[books.google.de]
  • Can interstitial nephritis be prevented or avoided? In most cases, there is nothing you can do to prevent interstitial nephritis. You can reduce your risk of getting it by avoiding medicines that can cause the condition.[familydoctor.org]
  • Appropriate Prophylaxis and Other Measures to Prevent Readmission. Avoid re-administration of drug class which led to AIN. **The original authors for this chapter was Dr. David Mintzer. The chapter was revised by Dr. Jacklyn Lee.[clinicaladvisor.com]
  • Often, the disorder can't be prevented. Avoiding or reducing your use of medicines that can cause this condition can help reduce your risk. If needed, your provider will tell you which medicines to stop or reduce.[medlineplus.gov]

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