Interstitial nephritis: Difference between revisions

Jump to navigation Jump to search
No edit summary
 
(5 intermediate revisions by 2 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
'''For patient information, click [[Interstitial nephritis (patient information)|here]]'''
'''For patient information, click [[Interstitial nephritis (patient information)|here]]'''
{{Interstitial nephritis}}
{{Interstitial nephritis}}


{{CMG}} {{AE}}{{M.B}}
{{CMG}} {{AE}}{{M.B}}{{MMJ}}


'''''Synonyms and keywords:''''' Tubulo-interstitial nephritis
'''''Synonyms and keywords:''''' Tubulointerstitial Nephritis
==[[Interstitial nephritis overview|Overview]]==
==[[Interstitial nephritis overview|Overview]]==
Two main diseases involve the renal tubules are:  [[Acute tubular necrosis]] (ATN) due to [[Ischemic]] or [[Toxic|toxic injury]]. (for more about ATN click [[Acute tubular necrosis|here]]), and tubulointerstitial nephritis (TIN) with [[Inflammatory]] involvement of tubules and [[interstitium]] and its consequent  reactions.
Since some  cases of involvement of renal tubulointerstitium are due  to bacterial infection, and the renal pelvis is deeply involved, therefore [[pyelonephritis]] is term describes this condition; and in general ,the term interstitial nephritis is used for TIN that are owing to nonbacterial causes of tubular injury such as  drugs, viral infections,[[Autoimmune disease|autoimmune systemic diseases]] , in which these condition mechanism of damage is due to activation of [[inflammatory responses]] not direct damage of [[Pathogens|microbial pathogens]].
==[[Interstitial nephritis historical perspective|Historical Perspective]]==
==[[Interstitial nephritis historical perspective|Historical Perspective]]==
* In 1938, Councilman was the first to discover the association between systemic infections and the development of TIN; in autopsy kidneys of children dying of [[diphtheria]] and [[scarlet fever]].
* He described the findings as: cellular and fluid exudation in the interstitial tissue of kidneys, before the era of antibiotics.
* The widespread use of renal biopsy and histological examination in TIN revealed a cellular  infiltration, which is dominantly  composed of [[T cells]], together with some [[macrophages]] and [[plasma cells]], and led to the discovery of similar findings in association with drug-related [[Renal insufficiency and failure|renal failure]] and the same conditions. 
==[[Interstitial nephritis classification|Classification]]==
==[[Interstitial nephritis classification|Classification]]==
There is no established system for the classification of TIN, however according to clinical manifestations and the [[inflammatory process]], TIN, in spite of the etiologic agent, can be divided into acute and chronic categories.


==[[Interstitial nephritis pathophysiology|Pathophysiology]]==
==[[Interstitial nephritis pathophysiology|Pathophysiology]]==
It is thought that acute interstitial nephritis is mediated by [[hypersensitivity reaction]] to endogenous or exogenous [[antigens]] expressed by [[Nephron|tubular cells]]. Numerous drugs such as [[antibiotics]], NSAIDS, [[Sulfa-containing antibiotics|sulfa-containing]] drugs, etc, as well as systemic diseases, and Infections may lead injury to renal cells. the cascade activation owing to cellular injury toward inflammatory cell infiltration, and activation of [[cytokines]] causes an immunologic reaction in acute or chronic process.
In acute interstitial nephritis, this cascade activation can cause renal tubular dysfunction, whereas in chronic interstitial nephritis an insidious interstitial [[fibrosis]],[[scarring]], , and [[Atrophy|tubular atrophy]] spreads gradually and causes progressive [[chronic renal insufficiency]].
==[[Interstitial nephritis causes|Causes]]==
==[[Interstitial nephritis causes|Causes]]==
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.


==[[Interstitial nephritis differential diagnosis|Differentiating Interstitial nephritis from other Diseases]]==
==[[Interstitial nephritis differential diagnosis|Differentiating Interstitial nephritis from other Diseases]]==


==[[Interstitial nephritis epidemiology and demographics|Epidemiology and Demographics]]==
==[[Interstitial nephritis epidemiology and demographics|Epidemiology and Demographics]]==
Interstitial nephritis accounts for 10-15% of kidney disease worldwide. [[Nephritis|Analgesic-induced nephritis]] is 5-6 times more common in women. The elderly have more severe disease and increased risk of permanent damage. Children exposed to [[lead poisoning]] are more likely to develop [[nephritis]] as young adult.
==[[Interstitial nephritis risk factors|Risk Factors]]==
==[[Interstitial nephritis risk factors|Risk Factors]]==
There are no established risk factors for TIN. Whereas according to etiologic causative factors, consumption of culprit drugs in causing TIN,previous history of [[hypersensitivity reactions]] to specific drug, presence of [[Autoimmune disease|autoimmune systemic disease]] or some [[neoplasia]] or genetic condition, occupational or environmental exposure to heavy metals , and infection etiologies in association with obstructive uropathy, play role in in the development of TIN.


==[[Interstitial nephritis natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
==[[Interstitial nephritis natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
In the majority of patients with TIN, recovery of [[renal function]] has been observed, and improvement immediately occurs upon stopping the offensive agent.
Nevertheless, about 12% of patients may progress to develop [[ESRD]] and its complications; and thus require [[dialysis]] or [[Organ transplant|transplantation]].
However there is no definite prognostic indicators for TIN, but [[Renal insufficiency|renal failure]] lasts for >3 weeks, older patients and presence of tubular atrophy and [[interstitial fibrosis]] in the renal biopsy are associated with worse prognosis.
==Diagnosis==
==Diagnosis==
[[Interstitial nephritis history and symptoms|History and Symptoms]] | [[Interstitial nephritis physical examination|Physical Examination]] | [[Interstitial nephritis laboratory findings|Laboratory Findings]] | [[Interstitial nephritis KUB x ray|KUB X Ray]] | [[Interstitial nephritis CT|CT]] | [[Interstitial nephritis MRI|MRI]] | [[Interstitial nephritis biopsy and ultrasound|Biopsy and Ultrasound]] | [[Interstitial nephritis other imaging findings|Other Imaging Findings]] | [[Interstitial nephritis other diagnostic studies|Other Diagnostic Studies]]
[[Interstitial nephritis history and symptoms|History and Symptoms]] | [[Interstitial nephritis physical examination|Physical Examination]] | [[Interstitial nephritis laboratory findings|Laboratory Findings]] | [[Interstitial nephritis KUB x ray|KUB X Ray]] | [[Interstitial nephritis CT|CT]] | [[Interstitial nephritis MRI|MRI]] | [[Interstitial nephritis biopsy and ultrasound|Biopsy and Ultrasound]] | [[Interstitial nephritis other imaging findings|Other Imaging Findings]] | [[Interstitial nephritis other diagnostic studies|Other Diagnostic Studies]]

Latest revision as of 01:33, 18 September 2019

For patient information, click here

Interstitial nephritis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Interstitial nephritis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Interstitial nephritis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Interstitial nephritis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Interstitial nephritis

CDC on Interstitial nephritis

Interstitial nephritis in the news

Blogs on Interstitial nephritis

Directions to Hospitals Treating Interstitial nephritis

Risk calculators and risk factors for Interstitial nephritis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohsen Basiri M.D.Mohamadmostafa Jahansouz M.D.[2]

Synonyms and keywords: Tubulointerstitial Nephritis

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Interstitial nephritis from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | KUB X Ray | CT | MRI | Biopsy and Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1

Template:Nephrology de:Interstitielle Nephritis

Template:WH Template:WS