Acute Allergic Interstitial Nephritis Flashcards
• Usually occurs within 2 weeks of therapy
Acute Allergic Interstitial Nephritis
the prototype
Methicillin-induced
presentation of Acute Allergic Interstitial Nephritis
Fever, maculopapular rash, eosinophilia, arthralgia, and
oliguria.
– Tubular dysfunction may be manifested by acidosis,
hyperkalemia, salt wasting, and concentrating defects
NSAID induced AIN
6-months, 70% have nephrotic
syndrome (proteinuria >3.5 g/day
the most definitive method for diagnosis For AIN
Renal biopsy
Pathogenesis of Acute Allergic Interstitial Nephritis
allergic sensitivity response,
granulomas and tubular epithelial cell necrosis are
common
• Risk factors:
Acute Allergic Interstitial Nephritis
No specific risk factors (idiosyncratic hypersensitivity
reactions)
– Individuals with other drug allergies may have increased
risk
Prevention of Acute Allergic Interstitial Nephritis
: monitor patient carefully, discontinuing the
offending drug
Managment of AIN
corticosteroid (prednisolone), monitor
kidney function
Chronic Interstitial Nephritis
- Lithium:
- Cyclosporine & Tacrolimus
- Aristolochic acid
Usually occurs after 10 to 20 years of treatment
lithium
– Nephrogenic diabetes insipidus is seen in up to 87% of patients
lithium
Presentation of lithium
Polydipsia
polyuria
20%, fibrosis in the first 5 years of therapy
Pathogenesis of lithium
Impaired ability to concentrate urine is a result of a
decrease in collecting duct response to antidiuretic hormone, which
may be related to downregulation of aquaporin 2 water channel
expression
risk factors of lithium
: long term therapy, age
Prevention of lithium CKD
Maintaining lithium concentrations as low as
therapeutically possible, avoiding dehydration, and
monitoring kidney function.
– Amiloride: prevention and treatment of nephrogenic diabetes
insipidus, since it blocks epithelial sodium transport of lithium into the
cortical collecting duct