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Interstitial Nephritis

Gemma Kim, MD and Yea Ping Lin, PhD, MD, MPH, MS, BS Reviewed 06/2022
 


BASICS

DESCRIPTION

  • Acute and chronic tubulointerstitial diseases result from the interplay of renal cells and inflammatory cells. Injury to renal cells leads to new local antigen expression, inflammato...

DIAGNOSIS

  • Renal biopsy is the gold standard diagnostic method.

  • AIN: suspected in a patient with nonspecific signs and vague symptoms of AKI (e.g., malaise, fever, nausea, vomiting) with an elevated ser...

TREATMENT

GENERAL MEASURES

  • Discontinue offending agent, including topical NSAIDs.

  • Reduce exposure to nephrotoxic agents.

  • Supportive measures:

    • Maintain adequate hydration.

    • Symptomatic relief for fever and r...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

If patients must remain on nephrotoxic agents, measure renal function, electrolytes, and phosphorus frequently. 

DIET

  • Low potassium (<2 g/day),...

REFERENCES

1
Muriithi  AK, Leung  N, Valeri  AM, et al. Clinical characteristics, causes and outcomes of acute interstitial nephritis in the elderly. Kidney Int.  2015;87(2...

CODES

ICD10

  • N12 Tubulo-interstitial nephritis, not spcf as acute or chronic

  • N10 Acute tubulo-interstitial nephritis

  • N11.9 Chronic tubulo-interstitial nephritis, unspecified

  • N16 Renal tubulo-interstitial d...

CLINICAL PEARLS

  • First step in treatment is to remove offending agents. Most common in elderly are proton pump inhibitors and antibiotics.

  • A renal biopsy is preferred to confirm AIN.

  • Immunosuppressive th...

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