Acute Interstitial Nephritis

Question 1

How does acute interstitial nephritis present?

Answer 1

rash, fever and eosinophilia
-> elderly patients are more commonly affected, flank pain, oliguria

Question 2

How does acute interstitial nephritis present?

Answer 2

rash, fever and eosinophilia
-> elderly patients are more commonly affected, flank pain, oliguria

Question 3

What are the bedside investigations for acute interstitial nephritis?

Answer 3

Urine microscopy shows pyuria and white cell casts; proteinuria may be present but is usually mild
Urine culture is negative (i.e. sterile pyuria)
Blood gas to assess for acidosis and hyperkalaemia that may complicate AKI
ECG looking for hyperkalaemic changes

Question 4

What is screened in the blood test?

Answer 4

*Full blood count may show eosinophilia (not present in all cases)
*U&Es to confirm renal impairment and assess electrolytes
*Autoimmune screen if an underlying autoimmune cause of AIN is suspected
*Antinuclear antibody (ANA)
*Anti-neutrophil cytoplasmic antibody (ANCA)
*Anti-double stranded DNA
*Complement

Question 5

What is the imaging for the acute interstitial nephritis?

Answer 5

-> Renal ultrasound
-> Kidneys are usually large

Question 6

What is the management of acute interstitial nephritis?

Answer 6

Steroids
Short course of oral prednisolone
Diuretics