Interstitial nephritis

Alternative Names: Tubulointerstitial nephritis; Nephritis – interstitial; Acute interstitial (allergic) nephritis

Definition:
Interstitial nephritis (or Tubulo-interstitial nephritis) is a form of nephritis affecting the interstitium of the kidneys surrounding the tubules  in which the spaces between the kidney tubules become swollen (inflamed).The inflammation can affect the kidneys’ function, including their ability to filter waste.
This disease can be either acute, meaning it occurs suddenly, or chronic, meaning it is ongoing and eventually ends in kidney failure.

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Acute interstitial nephritis is a kidney disorder in which the kidneys become unable to filter waste materials and fluid properly. This is a potentially serious condition that requires care from your doctor.

 

In chronic interstitial nephritis the kidney becomes small and granular with thickening of arteries and arterioles and proliferation of interstitial tissue. There may be functional abnormalities, such as urea retention, hematuria, and casts.

 

Symptoms:
Interstitial nephritis can cause mild to severe kidney problems, including acute kidney failure. In about half of cases, people will have decreased urine output and other signs of acute kidney failure.

Symptoms of this condition may include:

•Blood in the urine
•Fever
•Increased or decreased urine output
•Mental status changes (drowsiness, confusion, coma)
•Nausea, vomiting
•Rash
•Swelling of the body, any area
•Weight gain (from retaining fluid)

Causes:
Interstitial nephritis may be temporary (acute) or it may be long-lasting ( chronic) and get worse over time.

The following can cause interstitial nephritis:

•Allergic reaction to a drug (acute interstitial allergic nephritis)
•Analgesic nephropathy
•Long-term use of medications such as acetaminophen (Tylenol), aspirin, and nonsteroidal anti-inflammatory drugs (NSAIDS). This is called analgesic nephropathy
•Side effect of certain antibiotics (penicillin, ampicillin, methicillin, sulfonamide medications, and others)
•Side effect of medications such as NSAIDs, furosemide, and thiazide diuretics

The acute form of interstitial nephritis is common. It is most often caused by side effects of certain drugs. This disorder may be more severe and more likely to lead to chronic or permanent kidney damage in elderly people.

Complications:
Metabolic acidosis can occur because the kidneys aren’t able to remove enough acid. The disorder can lead to acute or chronic kidney failure or end-stage kidney disease.

Diagnosis:
At times there are no symptoms of this disease, but when they do occur they are widely varied and can occur rapidly or gradually.  When caused by an allergic reaction, the symptoms of acute tubulointerstitial nephritis are fever (27% of patients), rash (15% of patients),  and enlarged kidneys. 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. Other conditions that may develop include hyperkalemia, metabolic acidosis, and kidney failure.

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Blood tests:
About 23% of patients have eosinophilia.

Urinary findings:
Urinary findings include:
*Eosinophiluria: sensitivity is 67% and specificity is 83%.  The sensitivity is higher in patients with interstitial nephritis induced by methicillin or when the Hansel’s stain is used.

*Isosthenuria.

*Hematuria

*Sterile pyuria: white blood cells and no bacteria

Gallium scan
The sensitivity of an abnormal gallium scan has been reported to range from 60% to 100%.

Treatment:
Treatment focuses on the cause of the problem. Avoiding medications that lead to this condition may relieve the symptoms quickly.

Nutrition therapy consists of adequate fluid intake, which can require several liters of extra fluid.

Limiting salt and fluid in the diet can improve swelling and high blood pressure. Limiting protein in the diet can help control the buildup of waste products in the blood (azotemia) that can lead to symptoms of acute kidney failure.

If dialysis is necessary, it usually is required for only a short time.
Corticosteroids or anti-inflammatory medications can help in some cases.

Prognosis:
The kidneys are the only body system that are directly affected by tubulointerstitial nephritis. Kidney function is usually reduced; the kidneys can be just slightly dysfunctional, or fail completely.

In chronic tubulointerstitial nephritis, the most serious long-term effect is kidney failure. When the proximal tube is injured, sodium, potassium, bicarbonate, uric acid, and phosphate reabsorption may be reduced or changed, resulting in low bicarbonate, known as metabolic acidosis, low potassium, low uric acid known as hypouricemia, and low phosphate known as hypophosphatemia. Damage to the distal tubule may cause loss of urine-concentrating ability and polyuria.

In most cases of acute tubulointerstitial nephritis, the function of the kidneys will return after the harmful drug is not taken anymore, or when the underlying disease is cured by treatment. If the illness is caused by an allergic reaction, a corticosteroid may speed the recovery kidney function; however, this is often not the case.

Chronic tubulointerstitial nephritis has no cure. Some patients may require dialysis. Eventually, a kidney transplant may be needed.

Prevention:
In many cases, the disorder can’t be prevented. Avoiding or reducing your use of medications that can cause this condition can help reduce your risk.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://en.wikipedia.org/wiki/Interstitial_nephritis
http://www.nlm.nih.gov/medlineplus/ency/article/000464.htm
http://www.empowher.com/condition/acute-interstitial-nephritis
http://medical-dictionary.thefreedictionary.com/chronic+nephritis
http://www.humpath.com/spip.php?article2778&id_document=113#documents_portfolio

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