Interstitial nephritis natural history, complications and prognosis: Difference between revisions

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Latest revision as of 02:06, 2 August 2018

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

Overview

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 transplantation.

However there is no definite prognostic indicators for TIN, but 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.

Natural History, Complications, and Prognosis

Natural History

In the majority of patients with TIN, a full recovery or partial recovery occurs upon stopping the offensive agent. Meanwhile,about 12% of patients may progress to ESRD and its complications; and thus require dialysis or transplantation.^[1]

Complications

Common complications of TIN include:

Prognosis

In the majority of patients with TIN, a full recovery or partial recovery occurs upon stopping the offensive agent. Meanwhile,about 12% of patients may progress to ESRD and its complications; and thus require dialysis or transplantation.^[1]

It has been suggested that the long-term prognosis is worse if:

Renal failure lasts for >3 weeks.^[2]^[3]
Older patients^[4]
Presence of tubular atrophy and interstitial fibrosis in the renal biopsy. ^[5]

References

↑ ^1.0 ^1.1 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.
↑ Ditlove J, Weidmann P, Bernstein M, Massry SG. Methicillin nephritis. Med Balt 1977; 56: 483–491
↑ Laberke HG, Bohle A. Acute interstitial nephritis: correlations between clinical and morphological findings. Clin Nephrol 1980; 14: 263–273
↑ Kida H, Abe T, Tomosugi N et al. Prediction of the long-term outcome in acute interstitial nephritis. Clin Nephrol 1984; 22: 55–60
↑ Bhaumik SK, Kher V, Arora P et al. Evaluation of clinical and histological prognostic markers in drug-induced acute interstitial nephritis. Ren Fail 1996; 18: 97–104

Template:WH Template:WS

[BakerPusey2004-1] 1.0 ^1.1 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] Ditlove J, Weidmann P, Bernstein M, Massry SG. Methicillin nephritis. Med Balt 1977; 56: 483–491

[3] Laberke HG, Bohle A. Acute interstitial nephritis: correlations between clinical and morphological findings. Clin Nephrol 1980; 14: 263–273

[4] Kida H, Abe T, Tomosugi N et al. Prediction of the long-term outcome in acute interstitial nephritis. Clin Nephrol 1984; 22: 55–60

[5] Bhaumik SK, Kher V, Arora P et al. Evaluation of clinical and histological prognostic markers in drug-induced acute interstitial nephritis. Ren Fail 1996; 18: 97–104

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@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Interstitial nephritis}}
-{{CMG}}
+'''Editor-In-Chief:''' [[User:C Michael Gibson|C. Michael Gibson, M.S., M.D.]] [[Mailto:charlesmichaelgibson@gmail.com| [1]]]; '''Associate Editor(s)-in-Chief:'''{{M.B}}
-==Overview==
-Please help WikiDoc by adding content here.  It's easy!  Click  [[Help:How_to_Edit_a_Page|here]]  to learn about editing.
+== Overview ==
+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.
+== Natural History, Complications, and Prognosis ==
+=== Natural History ===
+* In the majority of patients with TIN, a full recovery or partial recovery occurs upon stopping the offensive agent. Meanwhile,about 12% of patients may progress to ESRD and its complications; and thus require dialysis or transplantation.<ref name="BakerPusey2004">{{cite journal|last1=Baker|first1=R. J.|last2=Pusey|first2=C. D.|title=The changing profile of acute tubulointerstitial nephritis|journal=Nephrology Dialysis Transplantation|volume=19|issue=1|year=2004|pages=8–11|issn=0931-0509|doi=10.1093/ndt/gfg464}}</ref>
+=== Complications ===
+* Common complications of TIN include:
+** [[Hypertension]]
+** [[Hypokalemia]]
+** [[hypouricemia]]
+** [[hypophosphatemia]]
+** [[metabolic acidosis]]
+** [[Proteinuria]]
+** [[ESRD]]
 ==Prognosis==
-The kidneys are the only body system that is directly affected by tubulointerstitial nephritis.  Kidney function is usually reduced; the kidneys can be just slightly dysfunctional, or fail completely.
+In the majority of patients with TIN, a full recovery or partial recovery occurs  upon stopping the offensive agent. Meanwhile,about 12% of patients may progress to  ESRD and its complications; and thus require dialysis or transplantation.<ref name="BakerPusey2004">{{cite journal|last1=Baker|first1=R. J.|last2=Pusey|first2=C. D.|title=The changing profile of acute tubulointerstitial nephritis|journal=Nephrology Dialysis Transplantation|volume=19|issue=1|year=2004|pages=8–11|issn=0931-0509|doi=10.1093/ndt/gfg464}}</ref>
-In chronic tubulointerstitial nephritis the most serious long term effect is [[kidney failure]].  When the proximal tubule is injured sodium, potassium, bicarbonate, uric acid, and phosphate intake may be reduced or changed, resulting in low bicarbonate, known as  [[metabolic acidosis]], [[hypokalemia]], low uric acid ([[hypouricemia]], and low phosphate ([[hypophosphatemia]]).  Damage to the distal renal tubule may cause loss of urine concentrating ability and [[polyuria]].
+==== It has been suggested  that the long-term prognosis is worse if: ====
+* Renal failure lasts for >3 weeks.<ref>Ditlove J, Weidmann P, Bernstein M, Massry SG. Methicillin nephritis. Med Balt  1977; 56: 483–491</ref><ref>Laberke HG, Bohle A. Acute interstitial nephritis: correlations between clinical and morphological findings. Clin Nephrol  1980; 14: 263–273</ref>  <ref />
+* Older patients<ref>Kida H, Abe T, Tomosugi N et al. Prediction of the long-term outcome in acute interstitial nephritis. Clin Nephrol  1984; 22: 55–60</ref>
+* Presence of tubular atrophy and interstitial fibrosis in the renal biopsy.<ref /> <ref>Bhaumik SK, Kher V, Arora P et al. Evaluation of clinical and histological prognostic markers in drug-induced acute interstitial nephritis. Ren Fail  1996; 18: 97–104</ref>
-In most cases of acute tubulointerstitial nephritis, the function of the kidneys will return after the harmful drug is not taken anymore, or when the underlying disease is cured by treatment.  If the illness is caused by an allergic reaction, a corticosteroid may speed the recovery kidney function, however this is often not the case.  Chronic tubulointerstitial nephritis has no cure.  Some patients may require [[dialysis]].  Eventually, a kidney transplant may be needed.
 ==References==
 {{reflist|2}}