Acute interstitial nephritis

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Acute tubulointerstitial nephritis:

Acute tubulointerstitial nephritis Dr Mohammed Abdelsattar

Kidney consist of ::

Kidney consist of :

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The term tubulointerstitial is used to broadly refer to kidney diseases that involve structures in the kidney outside the glomerulus . These diseases generally involve tubules and/or the interstitium of the kidney and spare the glomeruli

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All drugs can cause interstitial nephritis But the most common are:- AB as Rifampicin PPI Vit k frusamide NSAID

histopathologic findings in ATIN:

histopathologic findings in ATIN Presence of inflammatory cell infiltrate (CD41 T cells, macrophages, eosinophils , and plasma cells) Interstitial edema Normal glomeruli and vessels : This, in particular, distinguishes this disease process from inflammatory glomerular diseases (e.g., glomerulonephritides ) Granulomas located in the interstitium Immunofluorescence : linear deposition of immunoglobulin G ( IgG ) along the TBM Electron microscopy: diffuse effacement of the foot processes Interstitial fibrosis and tubular atrophy

latent period:

latent period there is usually a delay between the initial insult (exposure to offending drug or infectious agent) and the onset of decline in renal function From one day to weeks to months



laboratory manifestations of ATIN :

laboratory manifestations of ATIN > Azotemia (elevated BUN and serum creatinine ) >Peripheral eosinophilia > Eosinophiluria >Sterile pyuria (occasionally, white blood cell [WBC] casts) >Microscopic hematuria (very rarely, red blood cell [RBC] casts) > Proteinuria (usually in the non- nephrotic range) >Renal tubular acidosis

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However, eosinophiluria is a nonspecific finding that can be seen in a variety of conditions (e.g., acute pyelonephritis , acute glomerulonephritis , acute cystitis and prostatitis ). Its absence, however, does not exclude the diagnosis of ATIN

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urinary sediment can be helpful in excluding other causes of AKI. For instance, RBC casts are usually seen in acute glomerulonephritis and muddy-brown granular casts are seen in acute tubular necrosis (ATN). Normal urinalysis should not be used to exclude the diagnosis of ATIN

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Relation can be established Between the offending agent or drug and the onset of clinical and laboratory manifestations

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The only definitive and confirmatory diagnostic procedure is a renal biopsy indications for a renal biopsy in suspected ATIN : >AKI, whereby the diagnosis remains uncertain despite extensive laboratory testing, >Absence of any signs of improvement after withdrawal of suspected offending agent > In suspected ATIN cases, where immunosuppressive therapy is being considered


TTT >withdrawal of offending agent and avoidance of exposure to other potential nephrotoxic agents > Corticosteroid therapy (one mg/kg for 4-6w)

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