AIN and chronic interstitial nephritis Flashcards
Answer: medications
AIN is 10-15% of AKI
seen in DM and HIV
more meds in developed countries, more infections in under-developed countries
Common classes of meds that cause AIN
- abx
- NSAIDS
- PPI
- immune checkpoint inhibiters
Which PPIs are more noted to cause AIN?
- omep
- lansop
- pantop
*also cause of CKD down the line
5-aminosalicylates (5-ASA) are used to treat what AI-condition?
- AIN seen in what time period?
IBD - crohns/UC
- mesalamine, sulfasalazine, olsalazine
- around 1 year exposure
- can also be linked to CKD
- tx withdrawal and steroids
What is a severe systemic complication of allergic drug reaction with rash/fever/AIN/eosinophilia/LAD/pneumonitis/hepatitis (need 3 to dx)?
Name some implicated drugs?
DRESS Syndrome
- allopurinol
- sulfonamides
- phenytoin
- phenobarb
- carbamazepine
- vanco/linezolid
What is the most likely dx?
- weight loss (aristolochic acid) nephropathy
- obesity- related nephropathy
- NSAID-induced AIN
- DM nephropathy
- HCTZ-induced AIN
**also think Balkan endemic nephropathy - Serbia, Bosnia and Herzegovina, Croatia, Romania, and Bulgaria
Pathology and Treatment of aristolochic/balkan nephropathy?
NSAID - AIN/CIN review
AIN and papillary Ca from analgesic nephropathy
Other cases of AIN
- heavy metals
- other drugs
- herbs
- other
Summary/AIN for the boards
biopsy is diagnostic/gold standard
rest are seen/suggestive
What do you seen on urine sediment in AIN?
What percent is bland?
25%
What do you see on biopsy/pathology for AIN?
- normal/minimal glom changes
- tubulitis, can be dilated
- invasion of interstitium by cells (lymphocytes/macrophages/PMNs, eos)
- fibrosis
Steroids within 1 week
Tx: stop offending agent
can pulse vs PO pred 1mg/kg/day
Observational data: steroid patients have less HD requirement and better Cr sooner
What is the most likely dx?
- Sjogren’s AIN
- Sarcoid AIN
- TINU
- IgG4-AIN
- NSAID AIN
Sarcoid AIN
Tx: steroids - improved kidney function and less fibrosis on biopsy predicts recovery (likely to have CKD)
Sjogren’s
TINU
Lung mass biopsy with ‘lymphoplasmacytic infiltrate with reactive changes” but no cancer. Kidney biopsy obtained. Image on flip side.
What is the diagnosis?
- T-cell lymphoma
- IgG4 disease
- Sarcoid
- Castleman disease
- EGPA
IgG4 disease
What is the most appropriate treatment for the patient with IgG4 disease?
- MTX and Dex
- Cyc and steroids
- steroids
- MMF and steroids
- no Tx needed at this time
steroids alone.
- high IgG4, low complements
- single of multinodular mass in kidneys
- RP disease with obstruction
- hard to distinguish from lymphoma.
What pattern is seen on renal biopsy in IgG4 disease?
Interstitial fibrosis with “storiform” pattern or cartwheel appearance of fibroblasts/inflammatory cells
