Tubulointerstitial nephritis Flashcards
what is acute TIN?
immune-mediated hypersensitivity with either drugs or other antigens acting as haptans
what are the causes of TIN?
drug hypersensitivity in 70%
- NSAIDs
- abx- cephalosporins, penicillins, rifampicin, sulphonamide
- diuretics- furos, thiaz
- allopurinol
- cimetidine
infections in 15%
- staph, strep
immune disorders- SLE, sjogrens
what is the presentation of acute TIN?
fever, atrhalgia, rashes
AKI- oliguria/anuria
uveitis
what investigations could suggest acute TIN?
bloods- raised IgE, eosinophilia
urine dip- haematuria, proteinuria, sterile pyuria
what is the treatment of acute TIN?
stop offending drug
prednisolone
what is the prognosis of acute TIN?
most recover renal function
what is chronic TIN?
fibrosis and tubular loss
what are the causes of chronic TIN?
reflux + chronic pyelonephritis
diabetes
SCD or trait
what are the features of analgesic nephropathy?
sterile pyuria +/- mild proteinuria
slowly progressive CRF
sloughed papilla can lead to obstruction + renal colic
what are the investigations for analgesic nephropathy?
CT without contrast
show papillary calcifications
treatment- stop analgesics
what is acute urate crystal nephropathy?
AKI due to urate precipitations
usually after chemo-induced cell lysis
what is the treatment of acute urate crystal nephropathy?
hydration
urinary alkalinisation
what is nephrocalcinosis?
diffuse renal parenchymal calcification
progressive renal impairment
what are the causes of nephrocalcinosis?
malignancy
raised PTH
myeloma
sarcoidosis
vit D intoxification
RTA
what is the difference between ATN and TIN?
directly toxic -> ATN
cause hypersensitivity -> TIN
