2014, Number 05-06
<< Back Next >>
Medicina & Laboratorio 2014; 20 (05-06)
Biopsy-proven tubulointerstitial nephritis: A clinicopathological review
Cardona-Quiceno RA, Restrepo-Perdomo CA, Palacios-Quejada D, Arias-Restrepo LF
Language: Spanish
References: 30
Page: 241-252
PDF size: 416.22 Kb.
ABSTRACT
Introduction: Tubulointerstitial nephritis is one of the most frequent causes of acute kidney injury
that may progress to chronic kidney disease. The use and abuse of nephrotoxic drugs are the main cause.
Renal biopsy contributes to diagnosis in most cases.
Objective: To perform a clinical and pathologic
description of patients diagnosed with tubulointerstitial nephritis and their outcome.
Materials and
methods: outcome, renal biopsies and clinical records were reviewed.
Results: A total of 55 cases were included,
six child and 49 adults, on age range of five to 81 years, 61,8% of them were men. Of cases, 40 had acute
kidney injury, 10 chronic renal disease, three rapidly progressive glomerulonephritis, one nephritic
syndrome, and one sub-nephrotic proteinuria. All biopsies showed interstitial inflammation. The median
of initial serum creatinine was 4,6 mg/dL (0,7 – 23,0). Tubulointerstitial nephritis was associated to:
antibiotics (27,3%), nonsteroidal anti-inflammatory drugs (21,8%), toxins (7,3%), herbal medicines
(5,5%), others causes (12,7%) and unknown cause (25,5%). From 50 follow-up patients, 72% presented
complete remission and 28% chronic kidney disease.
Conclusions: Tubulointerstitial nephritis is
a renal disease with good prognosis. It is not possible to determine the causative factor in a significant
percentage of cases, so it is recommended to implement mechanisms of information to determine the
incidence, prevalence and etiologic factors in our population.
REFERENCES
Councilman WT. Acute interstitial nephritis. J Exp Med 1898; 3: 393-420.
Clarkson MR, Giblin L, O’Connell FP, O’Kelly P, Walshe JJ, Conlon P, et al. Acute interstitial nephritis: clinical features and response to corticosteroid therapy. Nephrol Dial Transplant 2004; 19: 2778-2783.
Rossert J. Drug-induced acute interstitial nephritis. Kidney Int 2001; 60: 804-817.
Nadasdy T, Sedmak D. Acute and chronic tubulointerstitial nephritis. In: Jennette JC, Olson JL, Schwartz MM, Silva FG, eds. Heptinstall’s Pathology of the Kidney (ed 6ta). Filadelfia-Nueva York, Estados Unidos: Lippincott-Raven; 2007.
Pettersson E, von Bonsdorff M, Törnroth T, H L. Clin Nephrol 1984; 22(5): 217-222.
Goicoechea M, Rivera F, Lopez-Gomez JM. Increased prevalence of acute tubulointerstitial nephritis. Nephrol Dial Transplant 2013; 28: 112-115.
Haas M, Spargo BH, Wit EJ, Meehan SM. Etiologies and outcome of acute renal insufficiency in older adults: a renal biopsy study of 259 cases. Am J Kidney Dis 2000; 35: 433- 447.
Wilson DM, Turner DR, Cameron JS, Ogg CS, Brown CB, Chantler C. Value of renal biopsy in acute intrinsic renal failure. Br Med J 1976; 2: 459-461.
Rostand SG, Kirk KA, Rutsky EA, Pate BA. Racial differences in the incidence of treatment for end-stage renal disease. N Engl J Med 1982; 306: 1276-1279.
Barsoum RS. Burden of chronic kidney disease: North Africa. Kidney Int Suppl (2011) 2013; 3: 164-166.
Murray T, Goldberg M. Chronic interstitial nephritis: etiologic factors. Ann Intern Med 1975; 82: 453-459.
González E, Praga M, Grupo Madrileño de Nefritis Intersticiales. ¿Cuándo tratar con esteroides a los pacientes con nefritis intersticial aguda por fármacos? Nefrología 2009; 29 (2): 95-98.
Baker RJ, Pusey CD. The changing profile of acute tubulointerstitial nephritis. Nephrol Dial Transplant 2004; 19: 8-11.
Ulinski T, Sellier-Leclerc AL, Tudorache E, Bensman A, Aoun B. Acute tubulointerstitial nephritis. Pediatr Nephrol 2012; 27: 1051- 1057.
Markowitz GS, Perazella MA. Drug-induced renal failure: a focus on tubulointerstitial disease. Clin Chim Acta 2005; 351: 31-47.
Koselj M, Kveder R, Bren AF, Rott T. Acute renal failure in patients with drug-induced acute interstitial nephritis. Ren Fail 1993; 15: 69-72.
Pusey CD, Saltissi D, Bloodworth L, Rainford DJ, Christie JL. Drug associated acute interstitial nephritis: clinical and pathological features and the response to high dose steroid therapy. Q J Med 1983; 52: 194-211.
Farrington K, Levison DA, Greenwood RN, Cattell WR, Baker LR. Renal biopsy in patients with unexplained renal impairment and normal kidney size. Q J Med 1989; 70: 221-233.
Praga M, Gonzalez E. Acute interstitial nephritis. Kidney Int 2010; 77: 956-961.
Gonzalez E, Gutierrez E, Galeano C, Chevia C, de Sequera P, Bernis C, et al. Early steroid treatment improves the recovery of renal function in patients with drug-induced acute interstitial nephritis. Kidney Int 2008; 73: 940- 946.
Racusen LC, Solez K, Colvin RB, Bonsib SM, Castro MC, Cavallo T, et al. The Banff 97 working classification of renal allograft pathology. Kidney Int 1999; 55: 713-723.
Howie AJ. Problems with ‘focal segmental glomerulosclerosis’. Pediatr Nephrol 2011; 26: 1197-1205.
Raza MN, Hadid M, Keen CE, Bingham C, Salmon AH. Acute tubulointerstitial nephritis, treatment with steroid and impact on renal outcomes. Nephrology (Carlton) 2012; 17: 748-753.
Lanewala A, Mubarak M, Akhter F, Aziz S, Bhatti S, Kazi JI. Pattern of pediatric renal disease observed in native renal biopsies in Pakistan. J Nephrol 2009; 22: 739-746.
Davison AM, Jones CH. Acute interstitial nephritis in the elderly: a report from the UK MRC Glomerulonephritis Register and a review of the literature. Nephrol Dial Transplant 1998; 13 Suppl 7: 12-16.
Cameron JS. Allergic interstitial nephritis: clinical features and pathogenesis. Q J Med 1988; 66: 97-115.
Muriithi AK, Leung N, Valeri AM, Cornell LD, Sethi S, Fidler ME, et al. Biopsy-proven acute interstitial nephritis, 1993-2011: a case series. Am J Kidney Dis 2014; 64: 558-566.
Lai MN, Lai JN, Chen PC, Hsieh SC, Hu FC, Wang JD. Risks of kidney failure associated with consumption of herbal products containing Mu Tong or Fangchi: a population-based case-control study. Am J Kidney Dis 2010; 55: 507-518.
Lai MN, Lai JN, Chen PC, Tseng WL, Chen YY, Hwang JS, et al. Increased risks of chronic kidney disease associated with prescribed Chinese herbal products suspected to contain aristolochic acid. Nephrology (Carlton) 2009; 14: 227-234.
Neilson EG. Mechanisms of disease: Fibroblasts-- a new look at an old problem. Nat Clin Pract Nephrol 2006; 2: 101-108.