ACUTE INTERSTITIAL

NEPHRITIS
MOHAMED UMAR
AMOUD SCHOOL OF MEDICINE
JULY 8, 2019
 • Acute interstitial nephritis (AIN) is a renal
lesion that typically causes a decline in renal
function and is characterized by an
inflammatory infiltrate in the kidney
interstitium.
INTRODUCTION • It is most often induced by drug therapy.
• AIN is also caused by autoimmune disorders
or other systemic disease, a variety of
infections remote to the kidney and
tubulointerstitial nephritis with uveitis
(TINU) syndrome.
ETIOLOGY

• The distribution of causes of AIN has been reported as follows:

• Drugs (70 to 75%).
• Infections (4 to 10%).
• Tubulointerstitial nephritis and uveitis (TINU) syndrome (5 to 10%).
• Systemic disease.
DRUGS
• The most common drug causes of AIN now
include
 Nonsteroidal antiinflammatory agents (NSAIDs)
 Penicillins and cephalosporins
 Rifampin
 Antimicrobial sulfonamides,
 Cipro
 Diuretics
 Cimetadine
 Proton pump inhibitors (PPIs)
 • Multiple organisms have been associated
with AIN including
• Legionella,
• Leptospira,
• Cytomegalovirus (CMV),
INFECTIONS • Streptococcus,
• Mycobacterium tuberculosis,
• Corynebacterium diphtheriae,
• Epstein-Barr virus (EBV), Yersinia,
polyomavirus, Enterococcus, Escherichia
coli, adenovirus, Candida, and others.
CLINICAL FEATURES

• Acute interstitial nephritis (AIN) causes AKI and its associated

symptoms.
• Rash, fever, and eosinophilia are the classical findings.
• Pyuria and hematuria may be present.
 LABORATORY AND
RADIOGRAPHIC FINDINGS
• Increased plasma creatinine
• Eosinophilia and eosinophiluria
• A characteristic urine sediment – The urine
sediment usually reveals white cells, red cells,
and white cell casts.
• There is no radiologic finding specific to AIN.
DIAGNOSIS
• Renal function tests (increased BUN and Cr levels)
• Urinalysis
a. Eosinophils in the urine suggest the diagnosis, given the proper history and
findings
b. Mild proteinuria or microscopic hematuria may be present
• Note that it is often impossible to distinguish AIN from ATN based on
clinical grounds alone. Renal biopsy is the only way to distinguish
between the two, but is usually not performed given its invasiveness.
TREATMENT

• Removing the offending agent is usually enough to reverse the

clinical findings.
• If creatinine continues to increase after stopping the offending
agent, steroids may help.
• Treat infection if present.
Thank you.