ACUTE INTERSTITIAL NEPHRITIS
- Acute interstitial nephritis is a kidney or renal dysfunctioning condition where being affected by it can rapidly decline the renal functioning.
- The word itself describes the nature of the disease and the term “Acute” denotes the sudden onset of disease with less than 3 months of duration , “Interstitial” denotes the surrounding area or tissue around the nephron ,”Nephritis” denotes inflammation to the nephron /
surrounding regions of the kidney .
The majority of the disease can happens due to long-term use of
I.Medications such as
Almost two thirds of cases are due to long-term use of medication
- Hypersensitivity drugs
- Antibiotics such as beta lactams,quinolones,cephalosporins,fluoroquinolones etc
- NSAIDS (Ibuprofen)
- Proton pump inhibitors (pantoprazole)
- Diuretics (Furosemide,Thiazides)
- 10-15% of cases have infections as underlying cause
- Attack from microorganisms such as E.coli,campylobacter,salmonella, streptococcus
- Viral infections Such as measles ,mumps ,HIV,CMV,EBV
- Fungal infections by histoplasmosis ,coccidiomycosis
- Protozoal infections such as toxoplasmosis
- It accounts for 10-15% of cases
- Systemic or immune diseases such as sjogren’s syndrome ,lupus and sarcoidosis
- 10-20% of Acute kidney injury is due to Acute interstitial nephritis
- 5-10% of cases have unknown etiology
- Diseases such as Anti-TBM,TINU syndrome
V.Too little potassium in blood (or) Too much calcium/uric acid in blood .
- Non-oliguric Acute kidney injury
- Nausea ,vomiting
- Flank pain
- Frequent urination
- Swelling of feet
- Pain or burning sensation during urination
- Drug induced- Acute interstitial nephritis has a classic triad in almost 10% cases
- Skin rash
- Low -grade fever
- More specific infections to underlying infection or illness
- In Drugs induced AIN , medications acts as haptens /proteins which binds to tubular cells to initiate a immune response
- May be for several weeks to months
- In infections induced AIN, Microorganisms antigens gets deposited in to interstitium which activates the immune response which on mediation can damage the kidneys
- Blood test
- Kidney biopsy is recommended for definitive diagnosis or for patients who are not responding even after withdrawal of the drugs or managing underlying conditions
- But biopsy is contraindicated in bleeding diathesis, solitary kidney,ESRD, Uncontrolled Hypertension,sepsis
- Imaging studies such as Renal ultrasonography can be used to study the increased or decreased size
- Sterile pyuria
- Leukocyte / WBC casts
- Proteinuria- subnephrotic stage
- Microscopic Hematuria casts ,rare
- Renal tubular
- Peripheral eosinophilia
- Eosinophiluria-predictive value of 38% is positive
- Serum creatinine profile -elevated BUN and creatinine suggest variable degree of renal injury
- Hyper /hypokalemia ,hyperchloremic metabolic acidosis suggest tubulointerstitial injury
- Fractional excretion of sodium (>1%)
- Elevated transaminase levels in drug induced injuries
- Supportive care
- Withdrawal of drugs and substitute with alternative drugs
- Managing fluid and electrolyte balance and hydration
- Removing the underlying etiology
- Corticosteroids should be initiated early which can results of recovery within 2 hours
- Prednisone -1mg/kg,orally -2 to 3 weeks followed by gradually tapering dose over 3-4 weeks
- If not responded , cyclophosphamide is considered
- In situations of severe damage to kidneys dialysis is considered
- Patients who discontinue medications can recover within 2 weeks of onset and more likely to recover than those who remained continuing for more than 3 or 4 weeks
- Adverse prognostic factors include inflammation occurring diffusely on biopsy ,elevated number of neutrophils,severity of interstitial fibrosis.
- There is a good prognostic value otherwise
Frequently asked questions
1.Is Acute interstitial nephritis serious?
- It is serious but can be treated if identified early
- In AIN, spaces between the nephrons get inflamed and reduce the functional ability of kidneys to filter.
- And in few cases they may end up in kidney failure
2.What usually causes Acute interstitial nephritis?
- Usually allergic reactions to medicated drugs and infections or other idiopathic conditions can cause acute interstitial nephritis
3.How does Acute interstitial nephritis feel like?
- Can range from mild to moderate or even severe kidney problems
- In almost half of the cases there is a decreases urine output and signs of acute kidney failure
- The symptoms include nausea ,vomiting malaise,flank pain,edema etc
4.How is Acute interstitial nephritis diagnosed ?
- Some suggest renal biopsy but not every patients should undergo this diagnostic test
- In few biopsy with histopathological findings shows plasma cells and lymphocytic infiltrates in the peritubular areas of interstitium with edema
- other tests include urine analysis also provide the evidence
5.Is Acute interstitial nephritis reversible?
- It totally depends upon the etiological cause
- In infection induced or idiopathic reasons then the disease is reversible
- If drug induced(NSAIDs) then there is a chance of permanent insufficiency in almost 40% of cases
6.What medications can cause nephritis?
- NSAIDS , Antibiotics, anti-inflammatory drugs and proton pump inhibitors
7.Can nephritis be cured
- May not be cured ,but can be treated as mentioned earlier
- Proper treatment can keep the condition on track and protect the kidneys
- It is important to follow the expert advice and instructions
- If kidney failure occurred there is no other way except undergoing dialysis or Transplantation
8.Does nephritis cause fatigue ?
- Yes,toxins ,metabolites does not filter properly into the urine instead ,build up in body causing swelling and fatigue
9.Can UTI cause nephritis
- Yes,Infections can spread from urinary tract to kidneys
- It can result in acute or even chronic Interstitial nephritis
10.Complications of Acute Interstitial nephritis
- Increased levels of cholesterol
- Chronic kidney disease or failure
11.What type of Hypersensitivity is acute interstitial nephritis
- It is a drug Hypersensitivity reaction or DHR
- can be manifested in a week or 2 after exposure to certain drugs
12.Does Acute interstitial nephritis cause Acute kidney injury?
- Classically Acute interstitial nephritis presents as acute kidney injury after the use of drugs or underlying systemic infections and sometimes often associated with pyuria,hematuria , proteinuria
13.Does Interstitial nephritis cause proteinuria?
- Not always but can cause proteinuria ranging from moderate to heavy proteinuria due to cytokine like permeability increasing factor secreted by inflammatory cells
14.Is Acute interstitial nephritis hereditary?
- The inheritance of one mutated gene from an affected parent can lead to disease
- Disease is autosomal -dominant conditions half of the offspring will have a chance of disease
15.What is allergic interstitial nephritis?
- It is one of the commonest form of acute interstitial nephritis
- The reason includes exposure to drugs
16.Does Acute interstitial nephritis cause pain ?
- If the cause of pyelonephritis ,symptoms of fever ,nausea ,vomiting and lower back pain is most common
17.What medications help kidney function?
- Angiotensin renin blockers and Angiotensin converting enzymes inhibitors decrease blood pressure and slow down the loss of kidney function
- Additionally they delay the progression of kidney failure
18.What fruits are great for kidneys?
- Pineapple ,grapes ,cranberries and apples are known to have known anti Inflammatory property and helps to heal, benefit the kidney health
19.How do you treat acute interstitial nephritis naturally?
- 2 teaspoons of crushed parsley juice with 1 spoon of honey consumed 3 times daily can improve the condition
- 1 glass of carrot juice + 1 tablespoon of lemon juice and honey consumed once daily for everyday during mornings on early stomach is another proven ayurvedic remedy
20.Natural diet which improves kidney health?
- As coconut water is an excellent diuretic ,while consuming 2 glasses of it daily can benefit
- Including bananas around 3-5 and 1 papaya in your diet.