Interstitial kidney disease

Question 1

What is interstitial nephritis?

Answer 1

Interstitial nephritis is term to describe a situation where there is inflammation of the space between cells and tubules (the interstitium) within the kidney. This is different to glomerulonephritis, where there is inflammation around the glomerulus. There are two types of interstitial nephritis: acute interstitial nephritis and chronic tubulointerstitial nephritis.

Question 2

Acute Interstitial Nephritis management and features?

Answer 2

Acute interstitial nephritis presents with acute kidney injury and hypertension. There is acute inflammation of the tubules and interstitium. This is usually caused by a hypersensitivity reaction to:

Drugs (e.g. NSAIDS or antibiotics)
Infection

Other features of a generalised hypersensitivity reaction can accompany the acute kidney injury:

Rash
Fever
Eosinophilia

Management involves treating the underlying cause. Steroids have a role in reducing inflammation and improving recovery.

Question 3

Chronic Tubulointerstitial Nephritis features and management?

Answer 3

Chronic tubulointerstitial nephritis involves chronic inflammation of the tubules and interstitium. It presents with chronic kidney disease.

It has a large number of underlying autoimmune, infectious, iatrogenic and granulomatous disease causes.

Management involves treating the underlying cause. Steroids have a role when guided by a specialist.