Tuesday, 3 December 2013

Nephritis: Interstitial nephritis (Tubulo-interstitial nephritis) - Diagnosis and Disease associated to

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.

Dr. Nikolić V and the research team in the review of the data between 1986 and 1997 of 21 patients, aged 7-16 years (mean, 12.8), with acute tubulointerstitial nephritis, including eight with tubulointerstitial nephritis and uveitis (TINU syndrome). Laboratory studies included urinalysis, complete blood count, erytrocyte sedimentation rate (ESR), plasma creatinine, glomerular filtration rate (GFR), electrolytes, proteins, IgG, C3, C4 antinuclear-antibodies (ANA), antistreptolysin-O and antibodies to hantaviruses. Renal ultrasound was done in all patients. Renal biopsy was performed in 5 children(11).

Diseases associated with interstitial nephritis
1. Crohn's Disease
There is a report of s case of of granulomatous interstitial nephritis (GIN) associated with Crohn's disease (CD) was reported. GIN is a rare pathological finding in renal biopsy specimens. In a patient affected by CD, granulomas may be found in various tissues and organs such as lymph nodes, mesentery, liver, and lungs and occasionally in bones, joints, and skeletal muscle. Few cases of granuloma have been reported in the kidney, and it is not always possible to relate the presence of granuloma to CD, to other interstitial granulomatosis diseases, or to a drug-induced reaction(5).

2. Sjögren's syndrome
In the study of the tissue distribution of cellular adhesion molecules (ICAM-1, ELAM-1, VCAM-1) was studied in specimens from six normal human kidneys and in six biopsies from kidneys with tubulointerstitial nephritis associated with Sjögren's syndrome, researchers at the Toho University School of Medicine, showed that adhesion molecules were thought to play a role in the pathogenesis of tubulointerstitial nephritis and sialoadenitis associated with Sjögren's syndrome. It was thus concluded that the same inflammatory process that took place in the salivary glands to induce the characteristic tissue change of Sjögren's syndrome likely was operative in the renal tubulointerstitial tissue as well(6).

3. Uveitisa
There is a report of Clinical features and natural course of acute tubulointerstial nephritis and uveitis (TINU syndrome) in five adolescent patients (3 girls and 2 boys), according to Dr. Nikolić V, and reseach team(7)

4. Tuberculosis
Tuberculosis (TB) is a common disease worldwide, but kidney affection, i.e. tubulointerstitial nephritis (TIN) caused by Mycobacterium tuberculosis is rare. More frequent in patients with TB is drug induced TIN, i.e. the result of intensive antitubercular treatment(8). 

5. Castleman's disease
There is a report of a case of mesangial proliferative glomerulonephritis with interstitial nephritis associated with multicentric Castleman's disease (MCD) successfully treated with an anti-interleukin-6 receptor antibody (tocilizumab)(9).

6. Feline morbillivirus
Feline morbillivirus, a previously undescribed paramyxovirus associated with tubulointerstitial nephritis in domestic cats(10)

7.  Etc.   

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(5) http://www.ncbi.nlm.nih.gov/pubmed/22871108
(6) http://www.ncbi.nlm.nih.gov/pubmed/9524776
(7) http://www.ncbi.nlm.nih.gov/pubmed/17974468 
(8) http://www.ncbi.nlm.nih.gov/pubmed/22704252 
(9) http://www.ncbi.nlm.nih.gov/pubmed/22687845 
(10) http://www.ncbi.nlm.nih.gov/pubmed/22431644 
(11)  http://www.ncbi.nlm.nih.gov/pubmed/15637986 

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