Interstitial nephritis causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohsen Basiri M.D.


Common causes of interstitial nephritis include drug side effects, particularly analgesics and antibiotics. Other common causes include associated nephrologic conditions, as well as microbial infections.



  • 70 to 75 percent (with antibiotics responsible for 30 to 49 percent of these cases)[1]
  • Any drug has the potentiality to cause AIN, among case reports of many drugs causing AIN, but only a few have been reported with biopsy-proven AIN. The most common proven drugs cause of AIN includes:[2][3][4][5][6][7]
  • Nonsteroidal anti-inflammatory agents (NSAIDs)
  • Penicillins and cephalosporins
  • Antimicrobial sulfonamides, including trimethoprim-sulfamethoxazole
  • Rifampin
  • Diuretics, including loop diuretics such as furosemide and bumetanide, and
  • Thiazide-type diuretics
  • Ciprofloxacin and, perhaps to a lesser degree other quinolones
  • Cimetidine
  • Allopurinol
  • Proton pump inhibitors such as omeprazole and lansoprazole
  • Indinavir
  • 5-aminosalicylates (eg, mesalamine)


Multiple organisms may cause TIN including bacterial viral fungal parasitic infections.[8][9][10][11][12][13]


  • Legionella,
  • Leptospira,
  • Streptococcus,
  • Mycobacterium tuberculosis,
  • Corynebacterium diphtheriae
  • Yersinia,
  • Enterococcus
  • Escherichia coli


  • Cytomegalovirus (CMV)
  • Epstein-Barr virus (EBV),
  • Aolyomavirus,
  • Adenovirus,
  • Candida


  • Leishmania
  • Toxoplasma

Immunologic diseases

  • Sarcoidosis
  • SLE,
  • Sjögren's syndrome

Less Common Causes

Less common causes of TIN include:

  • Heavy metals (eg, lead, cadmium, mercury)
  • Obstructive uropathy, nephrolithiasis, reflux disease
  • Neoplasia (eg, myeloma, leukemia, amyloidosis)
  • Metabolic diseases (eg, hypercalcemia, cystinosis, potassium depletion, hyperoxaluria)
Cardiovascular Granulomatosis with polyangiitis, Kawasaki's disease
Chemical/Poisoning Aristolochia, Quinine, Thiazide diuretics
Dental No underlying causes
Dermatologic Rubeola infection,
Drug Side Effect Acetaminophen  , Acyclovir, Aldomet, Allopurinol, Alpha-interferon, Amlodipine, Ampicillin, Anitrim, Anti-tubular basement membrane antibodies  , Apo-sulfatrim, Aspirin, Azathioprine, Bactelan, Batrizol, Bumetanide, Captopril, Carbamazepine, Cefaclor, Cefotaxime sodium, Cefoxitin sodium, Cephalosporin, Chlorthalidone, Cimetidine  , Ciprofloxacin, Clofibrate, Cox-2 inhibitors, Creatine, Dabrafenib mesylate, Diazepam, Diclofenac, Diflunisal, Diltiazem, Diphenylhydantoin, Diuretics, Doxycycline, Ectaprim, Enterobacticel, Erythromycin, Esteprim, Ethambutol, Famotidine, Fenoprofen, Flurbiprofen, Furosemide, Griseofulvin, Hydralazine, Hydrochlorothiazide, Ibuprofen, Indinavir, Indomethacin, Isobac, Isoniazid, Kelfiprim, Ketoprofen, Lansoprazole, Macrolides, Mesalamine, Mesalazine, Methicillin, Metoxiprim, Minocycline hydrochloride, Naproxen, Novo-trimel, Nu-cotrimox, Olsalazine, Omeprazole, Oxacillin, Oxaprozin, Oxytetracycline, Pegylated interferon alfa-2b, Penicillin , Phenindione, Phenobarbital, Phenteramine, Phenylpropanolamine, Phenytoin, Piperacillin/tazobactam, Piroxicam, Polymyxin, Pranlukast, Propylthioruacil, Pro-trin, Rabeprazole, Ranitidine, Rifampin, Roubac, Streptomycin, Sulfatrim ds, Sulfinpyrazone, Sulfonamide, Sulfoxaprim, Sulindac, Syraprim, Tenofovir disoproxil fumarate, Tetracycline, Thiazide diuretics, Tolmetin, Treponema, Triamterene, Trimesuxol, Trimethoprim-sulfamethoxazole, Trimetoger, Trimetox, Trimzol, Trisulfa, Trisulfam, Uroplus ds, Uroplus ss, Vancomycin
Ear Nose Throat Sjogren syndrome
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic Escherichia coli, Inflammatory bowel disease
Genetic Alport syndrome, Bardet-biedl syndrome
Hematologic Hypercalcemia, Hyperkalaemic distal renal tubular acidosis, Hyperuricemia, Hypokalemia, Sickle cell disease
Iatrogenic No underlying causes
Infectious Disease Adenovirus, Brucella, Candida, Chlamydia, Coccidioidomycosis, Corynebacterium diphtheriae, Cytomegalovirus, Diphtheria, Enterococcus, Epstein-barr virus  , Escherichia coli, Francisella, Hantaan virus, Histoplasmosis, Hiv infection, Legionellosis, Leishmaniasis, Leptospirosis, Mycobacterium tuberculosis, Mycoplasma infection, Polyomavirus, Rickettsia infection, Rubeola infection, Streptococcal infection, Syphilis, Toxoplasmosis, Uveitis, Yersinia
Musculoskeletal/Orthopedic No underlying causes
Neurologic No underlying causes
Nutritional/Metabolic Creatine, Hyperuricemia, Hypokalemia
Obstetric/Gynecologic No underlying causes
Oncologic Myeloma
Ophthalmologic Uveitis
Overdose/Toxicity Cocaine
Psychiatric No underlying causes
Pulmonary Hantaan virus, Histoplasmosis, Sarcoidosis
Renal/Electrolyte Alport syndrome, Granulomatosis with polyangiitis, Hyperkalaemic distal renal tubular acidosis, Reflux nephropathy, Renal failure, Sensenbrenner syndrome, Tubulointerstitial nephritis, Wegener's granulomatosis
Rheumatology/Immunology/Allergy Igg4-related disease, Kawasaki's disease, Sarcoidosis, Sicca syndrome, Systemic lupus erythematosus
Sexual Hiv infection, Syphilis
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous No underlying causes

Causes in Alphabetical Order


  1. Baker, R. J.; Pusey, C. D. (2004). "The changing profile of acute tubulointerstitial nephritis". Nephrology Dialysis Transplantation. 19 (1): 8–11. doi:10.1093/ndt/gfg464. ISSN 0931-0509.
  2. Neilson EG. Pathogenesis and therapy of interstitial nephritis. Kidney Int 1989; 35:1257
  3. Ten RM, Torres VE, Milliner DS, et al. Acute interstitial nephritis: immunologic and clinical aspects. Mayo Clin Proc 1988; 63:921
  4. Michel DM, Kelly CJ. Acute interstitial nephritis. J Am Soc Nephrol 1998; 9:506
  5. Michel DM, Kelly CJ. Acute interstitial nephritis. J Am Soc Nephrol 1998; 9:506
  6. Torpey N, Barker T, Ross C. Drug-induced tubulo-interstitial nephritis secondary to proton pump inhibitors: experience from a single UK renal unit. Nephrol Dial Transplant 2004; 19:1441
  7. Wang YC, Lin YF, Chao TK, et al. Acute interstitial nephritis with prominent eosinophil infiltration. Clin Nephrol 2009; 71:187
  8. Kodner CM, Kudrimoti A. Diagnosis and management of acute interstitial nephritis. Am Fam Physician 2003; 67:2527
  9. Muriithi AK, Leung N, Valeri AM, et al. Biopsy-proven acute interstitial nephritis, 1993-2011: a case series. Am J Kidney Dis 2014; 64:558
  10. Chang JF, Peng YS, Tsai CC, et al. A possible rare cause of renal failure in streptococcal infection. Nephrol Dial Transplant 2011; 26:368
  11. Agrawal V, Crisi GM, D'Agati VD, Freda BJ. Renal sarcoidosis presenting as acute kidney injury with granulomatous interstitial nephritis and vasculitis. Am J Kidney Dis 2012; 59:303
  12. Farr RW. Leptospirosis. Clin Infect Dis 1995; 21:1.
  13. Baksh FK, Finkelstein SD, Swalsky PA, et al. Molecular genotyping of BK and JC viruses in human polyomavirus-associated interstitial nephritis after renal transplantation. Am J Kidney Dis 2001; 38:354

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