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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 is defined by tubular atrophy accompanying the inflammation.

In our case, renal disease was associated with prior use of an antibiotic (ciprofloxacin), an NSAID (ibuprofen) and naturopathic medicine (flower of Jamaica), these three types of medicamntos have been associated, with variable frequency, with nephritis tubulointerstitial, it is impossible to accurately determine which of them was responsible or if everyone contributed to the renal disease.

Fifteen days after biopsy renal function was normal, without specific treatment, she did not receive steroids.

See the Chapter Tubulointerstitial Diseases of our Tutorial.

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References

• 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]
• Alper AB. Tubulointerstitial Nephritis. In eMedicina. Consulted: April 26th. [Link to the Website]
• Tanaka T, Nangaku M. Pathogenesis of tubular interstitial nephritis. Contrib Nephrol. 2011;169:297-310. [PubMed link]
• Perazella MA, Markowitz GS. Drug-induced acute interstitial nephritis. Nat Rev Nephrol. 2010;6(8):461-70. [PubMed link]
• Praga M, González E. Acute interstitial nephritis. Kidney Int. 2010;77(11):956-61. [PubMed link]
• 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]

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