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

symptoms:

symptoms

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:

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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