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Diagnosis: Acute tubulointerstitial nephritis
Tubulointerstitial nephritis is primary injury to renal tubules and interstitium resulting in decreased renal function. The acute form is most often due to allergic drug reactions or to infections. The chronic form occurs with a diverse array of causes, including genetic or metabolic disorders, obstructive uropathy, and chronic exposure to environmental toxins or to certain drugs and herbs (Tubulointerstitial nephritis, in: The Merck Manuak [Link]).
Acute tubulointerstitial nephritis involves an inflammatory infiltrate and edema affecting the renal interstitium that often develops over days to months. Over 95% of cases result from infection or an allergic drug reaction.
Chronic tubulointerstitial nephritis arises when chronic tubular insults cause gradual interstitial infiltration and fibrosis, tubular atrophy and dysfunction, and a gradual deterioration of renal function, usually over years.
In our case, renal disease was associated with prior use of an herbal product. There are frequently described cases of renal and hepatic toxicity associated with this "natural" products and in many cases (at least in our country) this products do not inform about their composition. Before consuming these products or "natural drugs", it is very important to be well informed, consult a doctor and buy only in trustworthy sites.
See the chapter Tubulointerstitial Diseases of our tutorial.
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References
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Ulinski T, Sellier-Leclerc AL, Tudorache E, Bensman A, Aoun B. Acute tubulointerstitial nephritis. Pediatr Nephrol. 2011 Jun 3. [Epub ahead of print] [PubMed link]
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Tanaka T, Nangaku M. Pathogenesis of tubular interstitial nephritis. Contrib Nephrol. 2011;169:297-310. [PubMed link]
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Perazella MA, Markowitz GS. Drug-induced acute interstitial nephritis. Nat Rev Nephrol. 2010;6(8):461-70. [PubMed link]
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Praga M, González E. Acute interstitial nephritis. Kidney Int. 2010;77(11):956-61. [PubMed link]
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González E, Praga M; Grupo Madrileño de Nefritis Intersticiales.[When to use steroid treatment for those patients with drug-induced acute interstitial nephritis?]. Nefrologia. 2009;29(2):95-8. [PubMed link] [Free full text]