Acute Interstitial Nephritis


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 nephritis cases
  • Tubulointerstitial Nephritis and Uveitis Syndrome (TINU): accounts for 5-10% of acute interstitial nephritis cases
  • Multisystem Diseases (Systemic Lupus Erythematosus, Sjogren’s Syndrome, etc): account for 10-20% of acute interstitial nephritis cases

Etiology

Drug-Induced (Allergic) Interstitial Nephritis

Anti-Inflammatories

Antibiotics

Diuretics

Proton Pump Inhibitors (PPI’s)

Other

Infectious Interstitial Nephritis

Viral

Bacterial

Fungal

  • Candidiasis (see Candida)
  • Coccidioidomycosis (see Coccidioidomycosis)
    • Produces a Histologic Variant of Acute Interstitial Nephritis with Associated Granuloma Formation
  • Histoplasmosis (see Histoplasmosis)
    • Produces a Histologic Variant of Acute Interstitial Nephritis with Associated Granuloma Formation

Parasitic

  • Leishmaniasis (see Leishmaniasis)
    • Produces a Histologic Variant of Acute Interstitial Nephritis with Associated Granuloma Formation
  • Toxoplasmosis (see Toxoplasmosis)
    • Produces a Histologic Variant of Acute Interstitial Nephritis with Associated Granuloma Formation

Infiltrative Interstitial Nephritis

Vasculitis-Associated Interstitial Nephritis

Other Etiologies of Interstitial Nephritis

  • Acute Renal Allograft/Transplant Rejection (see Renal Transplant)
  • Immunoglobulin G4-Related Disease (IgG4-Related Disease) (see Immunoglobulin G4-Related Disease)
    • Epidemiology: acute interstitial nephritis is the most common renal manifestation of IgG4-related disease
  • Intravenous Drug Abuse (IVDA)
  • Radiation Nephritis (see Radiation Therapy)
  • Idiopathic Interstitial Nephritis

Physiology


Diagnosis


Clinical Manifestations

General Comments

  • Asymptomatic Cases: many cases may be asymptomatic
  • Latency of Onset in Drug-Induced Acute Interstitial Nephritis: latency typically ranges from 3-5 days to months
    • Rifampin: latency may be as short as 1 day
    • NSAID’s: latency may be as long as 18 mo

Renal Manifestations

  • Acute Kidney Injury (AKI) (see Acute Kidney Injury)
  • Eosinophiluria
  • Gross Hematuria (see Hematuria): occurs in only 5% of cases
  • Nephrotic Syndrome (see Nephrotic Syndrome): occurs in <1% of cases
    • However, in NSAID-associated acute interstitial nephritis cases, co-existing membranous nephropathy or minimal change disease may produce nephrotic syndrome
  • Oliguria: occurs in 51% of cases

Other Manifestations

Allergic-Type Symptoms

  • Epidemiology
    • Although these symptoms have been classically associated with acute interstitial nephritis, they are less commonly-observed in the modern era [MEDLINE]
    • NSAID-related acute interstitial nephritis cases are less associated with these allergic-type symptoms, as compared to other drugs
  • Clinical
    • Arthralgias (see Arthralgias): occur in 45% of cases
    • Fever (see Fever): occurs in 27% of cases
    • Peripheral Eosinophilia (see Peripheral Eosinophilia): occurs in 23% of cases
    • Rash: occurs in 15% of cases
    • Triad of Fever + Peripheral Eosinophilia + Rash: occurs in 10% of cases

Treatment


References

General

Etiology