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Kidney Biopsy of the Month – Acute Interstitial Nephritis

Acute interstitial nephritis (AIN) is a common cause of acute kidney injury (AKI), estimated to account for 15-20% of cases of AKI. The term AIN does not refer to a specific disease, but rather indicates an immune-mediated form of tubulointerstitial injury which may result from a variety of underlying causes. Drug hypersensitivity accounts for the majority of cases (~70%), with the remaining cases attributable to systemic or direct renal infections, autoimmune diseases, hereditary and metabolic disorders, obstruction/reflux, or unknown causes. AIN also frequently accompanies glomerulonephritis and/or vasculitis. Notably, hematologic malignancies and lymphoproliferative disorders can directly…

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Articles of Interest

Acute interstitial nephritis

Acute interstitial nephritis (AIN) represents a frequent cause of acute kidney injury, accounting for 15–27% of renal biopsies performed because of this condition. By and large, drug-induced AIN is currently the commonest etiology of AIN, with antimicrobials and nonsteroidal anti-inflammatory drugs being the most frequent offending agents.

Acute Interstitial Nephritis: A Rare and Unusual Side Effect of Omalizumab

Acute interstitial nephritis (AIN) is a relatively common cause of acute kidney injury with etiologies that include drug therapy, infections, and systemic diseases. Of these etiologies, drug therapy accounts for ~70% of AIN cases. Although any drug can cause AIN, there are no reported cases of AIN caused by omalizumab, a humanized monoclonal antibody that binds to and inhibits circulating immunoglobulin E.

Chronic Interstitial Nephritis

Chronic interstitial nephritis is a nonspecific diagnosis of a pattern of kidney injury, which may occur due to any of many conditions that initially cause an acute interstitial nephritis. The diagnosis is made when specific underlying causes cannot be identified. Patients may present at any age, usually with low-grade proteinuria and slowly progressive decline in glomerular filtration rate, and may reach end-stage kidney disease. Fanconi syndrome may be present, with glycosuria and aminoaciduria.

Chronic interstitial nephritis in agricultural communities: a worldwide epidemic with social, occupational and environmental determinants

Two hypotheses emphasizing different primary triggers have been proposed: one related to toxic exposures in the agricultural communities, the other related to heat stress with repeated episodes of dehydration heath stress and dehydration

Diagnosis and Management of Acute Interstitial Nephritis

Acute interstitial nephritis is an important cause of acute renal failure resulting from immune-mediated tubulointerstitial injury, initiated by medications, infection, and other causes. Acute interstitial nephritis may be implicated in up to 15 percent of patients hospitalized for acute renal failure.

Keeping it Renal: Drug-Induced Acute Interstitial Nephritis

Acute interstitial nephritis (AIN) is the third most common cause of acute kidney injury (AKI) after prerenal AKI and acute tubular necrosis. Over two-thirds of AIN cases are drug-induced and infection-related AIN accounts for 5% to 10% of cases.

Kidney Boy on Acute Kidney Injury: Myths & Musings

A very difficult diagnosis – so many other usual suspects normally at play (vancomycin, pressors, contrast, etc.). AIN should be considered a diagnosis of exclusion, in many cases.

New challenges in tubulointerstitial nephritis induced by drugs

Drug-induced acute TIN is a consequence of a hypersensitivity reaction that promotes the onset of the inflammatory cascade in the renal parenchyma and which, if not controlled, can lead to tubular atrophy and fibrosis. Theoretically, the use of immunosuppressive medication, which includes steroids, may limit inflammation and also, therefore, the subsequent development of fibrosis. In fact, some retrospective studies have suggested that the use of steroids accelerates and intensifies renal recovery after drug-related acute TIN, but not all studies are in agreement.

On the Etymology of Nephritis: A Historical Appraisal of its Origins

For most of medical history the kidney was considered a glandular secretory organ subservient to nutrition for the elimination of excess “fluidities.” When the kidney failed or as then considered “not strong enough,” the accumulated excess fluidities (hydremia, hydremic plethora) were considered to collect in serous spaces as “hydrops, hydropsy, or dropsy,” ancient terms popularized in the early 1700s. The principal renal ailments then considered were obstruction (dropsy of the kidney) and calculous disease (calculous nephritis), but it was studies on dropsy that led to the identification of the actual wider range of nephritic diseases.

Test Your Knowledge: Interstitial Nephritis

In a recent article published in AJKD, Muriithi et al report a large series of 133 patients who had biopsy-proven acute interstitial nephritis at a single center. The following questions will test your pathology knowledge on this topic.

Update on Lupus Nephritis

SLE is a chronic inflammatory disease that affects the kidneys in about 50% of patients. Lupus nephritis is a major risk factor for overall morbidity and mortality in SLE, and despite potent anti-inflammatory and immunosuppressive therapies still ends in CKD or ESRD for too many patients.

Resources

American Kidney Fund

Acute interstitial nephritis is usually caused by an allergic reaction or other type of reaction to a medicine or drug that you take. The symptoms of acute interstitial nephritis can happen quickly. There are more than 100 different medicines that might cause acute interstitial nephritis. Chronic interstitial nephritis is usually caused by another health problem you have.

BMJ Best Practice

Acute interstitial nephritis (AIN) is caused by acute inflammation of the renal tubulo-interstitium, commonly mediated by a hypersensitivity reaction to medications. Autoimmune diseases and infections are less common causes.