Interstitial nephritis

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Revision as of 19:22, 14 July 2020 by Aidan (talk | contribs) (Text replacement - "Clinical Presentation" to "Clinical Manifestations")

Etiology

Drugs

  • Nonsteroidal antiinflammatory agents (NSAIDs)
    • Includes selective cyclooxygenase (COX)-2 inhibitors and mesalamine
  • Antimicrobials
    • Penicillins and cephalosporins
    • Rifampin
    • Trimethoprim-sulfamethoxazole
    • Ciprofloxacin
    • Indinavir
  • Diuretics, including furosemide and thiazides
  • Cimetidine
  • Allopurinol
  • Proton pump inhibitors (PPIs)

Infections

Long list, including Legionella, Leptospira, cytomegalovirus (CMV), Streptococcus, Mycobacterium tuberculosis, Corynebacterium diphtheriae, Epstein-Barr virus (EBV), Yersinia, polyomavirus, Enterococcus, Escherichia coli, adenovirus, and Candida.

Autoimmune Disorders

  • Systemic lupus erythematosus
  • Sarcoidosis
  • Sjögren syndrome
  • IgG4 disease

Clinical Manifestations

  • Can be asymptomatic, presenting with renal dysfunction
  • Nausea, vomiting, malaise, and oliguria
  • May have arthralgias
  • With drug-induced AIN, can have an allergic syndrome that includes fever, eosinophilia, and rash

Investigations

  • Creatinine, showing AKI
  • CBC, showing eosinophilia
  • Urine studies
    • May have pyuria and white cell casts and RBCs, and eosinophiluria
    • Usually around 1 g/day of proteinuria
    • FENa >1%