Tuesday, 3 December 2013

Nephritis: Interstitial nephritis (Tubulo-interstitial nephritis) - Causes and Risk Factors

Nephritis is defined as a condition of inflammation of the nephrons in the kidneys.
Interstitial nephritis (Tubulo-interstitial nephritis) 
Interstitial nephritis is defined as a condition of inflammation of the spaces between renal tubules, affecting the interstitium of the kidneys and kidney function in wast removal.

Causes and Risk factors
1. In the study of The outcome of acute interstitial nephritis: risk factors for the transition from acute to chronic interstitial nephritis, researchers at the Department of Nephrology, MHH, Hannover, Germany, in determination of risk factors for the development of chronic renal insufficiency, and thus, the transition from acute to chronic interstitial nephritis, showed that acute interstitial nephritis was found in 6.5% of all biopsies (64 patients with 68 episodes of acute interstitial nephritis); it was infection-induced in 10%, idiopathic in 4%, and drug-induced in 85% of the cases (antibiotics in 13 cases, analgesics in 17, non-steroidal anti-inflammatory drugs (NSAIDs) in 16, diuretics in 5, and various other drugs in 7). Renal insufficiency was reversible in 69% and permanent in 31% (12% partially reversible, 19% irreversible). The infection-induced and idiopathic types of acute interstitial nephritis were always reversible. Drug-related acute interstitial nephritis caused permanent renal insufficiency in 36% with a maximum of 56% in NSAID-induced cases. In drug-induced cases, intake of the suspected drug for more than a month prior to diagnosis caused permanent renal insufficiency in 88% and interstitial granuloma in 31%(2).

2. Impaired potassium and magnesium homeostasis and urinary losses are associated with the increased risk of acute tubulo-interstitial nephritis(3)

3. Hypercalcemia is a life-threatening disorder and is related primarily to neoplastic diseases and primary and secondary hyperparathyroidism and associated to the risk of Interstitial nephritis(4).

4. Allergic effect
A severe generalized multisystem allergic reaction occurred in a 16-month-old infant following the use of trimethoprim-sulfamethoxazole. Acute interstitial nephritis developed three weeks following the onset of this reaction and resolved after three months. This is the first description of this renal toxicity with TMP-SMX in a child(4a).

5. Etc.  

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(2) http://www.ncbi.nlm.nih.gov/pubmed/11020015
(3) http://www.ncbi.nlm.nih.gov/pubmed/4058627
(4) http://www.ncbi.nlm.nih.gov/pubmed/19356379 
(4a) http://www.ncbi.nlm.nih.gov/pubmed/7149348 

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