Chapter

Acute interstitial nephritis

Simon D. Roger

in Oxford Textbook of Medicine

Published on behalf of Oxford University Press

Published in print May 2010 | ISBN: 9780199204854
Published online May 2011 | e-ISBN: 9780199570973 | DOI: http://dx.doi.org/10.1093/med/9780199204854.003.210901_update_001
Acute interstitial nephritis

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Acute interstitial nephritis (AIN) is an inflammation of the tubules and interstitium within the kidney, associated with relatively sudden onset and fast decline in renal function. It is usually secondary to drugs (proton pump inhibitors being most commonly incriminated), with other causes being infections (classically streptococcal, but this is now less common) and immune disorders (systemic lupus erythematosus, sarcoidosis, and tubulointerstitial nephritis with uveitis).

Clinical features—the diagnosis of AIN should be considered in any patient with unexplained acute renal failure. Drug-induced AIN may present with a classic allergic response, including arthralgias, fever, rash, loin pain, and eosinophilia/eosinophiluria, but these are not invariable and their absence does not exclude the diagnosis. The urine typically shows low-grade proteinuria (<1 g/day). Renal biopsy is the only way to confirm or exclude the diagnosis.

Management and prognosis—treatment is by removing the offending agent, treating the concurrent infectious cause, or managing the immune aetiology, with or without steroids (typically prednisolone 1 mg/kg per day, tapered to zero over 6–8 weeks). Most patients with drug-induced AIN recover renal function, but some are left with chronic renal impairment, and a small proportion progress to endstage chronic kidney disease.

Chapter.  3271 words.  Illustrated.

Subjects: Nephrology

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