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Interstitial Nephritis

Narothama Reddy Aeddula, MD, FACP, FASN, Samata Pathireddy, MD and Subhasish Bose, MD, FASN Reviewed 06/2019
 


BASICS

DESCRIPTION

  • Acute and chronic tubulointerstitial diseases result from the interplay of renal cells and inflammatory cells. Lethal or sublethal injury to renal cells leads to new local antigen ex...

DIAGNOSIS

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

    • AKI

      • Elevated creati...

TREATMENT

For AIN, data on corticosteroids’ efficacy have been limited (4)[B]. 

GENERAL MEASURES

  • Discontinue offending agent including topical NSAIDs.

  • Reduce exposure to nephrotoxic agents (e.g., furosem...

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)

  • L...

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):458–464. [View Abstract o...

ADDITIONAL READING

  • Fouque D, Laville M. Low protein diets for chronic kidney disease in non diabetic adults. Cochrane Database Syst Rev.  2009;(3):CD001892. [View Abstract on OvidMedline]

  • Raghavan...

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 OFA.

  • Most common OFA in elderly is proton pump inhibitors and antibiotics.

  • A renal biopsy is preferred to confirm AIN.

  • Immunosuppressive therapy is em...

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