Nephrology Book

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Acute Interstitial NephritisAka: Acute Tubulointerstitial Nephritis, Allergic Interstitial Nephritis, Interstitial Nephritis, AIN

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  1. See Also
    1. Nephrotoxic Drugs
  2. Pathophysiology
    1. Renal interstitial inflammation
    2. T-Cell mediated Hypersensitivity Reaction
  3. Causes
    1. Infection
      1. Diphtheria (classic)
      2. Group A beta hemolytic Streptococcus (classic)
      3. Legionella
      4. Yersinia
      5. Staphylococcus or Streptococcus infection
      6. Mycobacterium
      7. Toxoplasmosis
      8. Mycoplasma
      9. Leptospira
      10. Rickettsia
      11. Syphilis
      12. Herpes viruses (e.g. CMV, EBV, HSV)
      13. Human Immunodeficiency Virus (HIV)
      14. Hantavirus
      15. Hepatitis C
      16. Mumps
    2. Medications (AIN occurs >2 weeks after drug started)
      1. Penicillins and Cephalosporins
        1. Hypersensitivity (fever, rash, arthralgia)
      2. Sulfonamides
        1. Vasculitis reaction
      3. NSAIDs
        1. Nephrotic Syndrome type reaction
      4. Rifampin
      5. Diuretics (Thiazides and Lasix)
      6. Allopurinol
      7. Cimetidine
      8. Ciprofloxacin
      9. Dilantin
      10. Other medications have caused AIN to a lesser extent
    3. Miscellaneous conditions
      1. Glomerulonephritis
      2. Necrotizing Vasculitis
      3. Systemic Lupus Erythematosus
      4. Acute kidney transplant rejection
  4. Symptoms and Signs
    1. Classic triad (Methicillin induced hypersensitivity)
      1. Low grade fever (>70% of cases)
      2. Rash (>30% of cases)
      3. Arthralgia (>15% of cases)
    2. Acute Renal Failure
      1. Oliguria
      2. Malaise
      3. Nausea or Vomiting
  5. Labs: General
    1. Urinalysis
      1. Eosinophiluria
      2. Proteinuria
      3. Fractional Excretion of Sodium >1%
    2. Renal Function tests with renal insufficiency
      1. Serum Creatinine increased
      2. Blood Urea Nitrogen increased
    3. Miscellaneous
      1. Hyperchloremic Metabolic Acidosis
  6. Labs: Renal biopsy
    1. Inflammation of renal interstitium
      1. Mononuclear cell and T-Lymphocyte infiltrate
    2. Glomerular and vascular sparing
  7. Management
    1. Consider Corticosteroid course
      1. Initial: Prednisone 1 mg/kg/day PO for 2 weeks
      2. Next: Prednisone tapered off over 3-4 weeks
      3. Consider cyclophosphamide in steroid non-responders
    2. Eliminate possible causes
    3. Optimize fluid status
    4. Manage Hyperkalemia and other electrolyte abnormalities
    5. Symptomatic relief of fever and arthralgias
    6. Avoid nephrotoxic medications
  8. Prognosis
    1. Recovery in weeks if cause eliminated within 2 weeks
    2. Renal biopsy findings suggestive of poor prognosis
      1. Diffuse inflammation
      2. Neutrophils >1%
      3. Significant interstitial fibrosis
  9. Complications
    1. Acute Renal Failure (Acute Tubular Necrosis)
      1. Responsible for up to 15% of Acute Renal Failure
  10. References
    1. Kodner (2003) Am Fam Physician 67(12):2527
    2. Michel (1998) J Am Soc Nephrol 9:506

Nephritis, Interstitial (C0027707)

Definition (MSH)Inflammation of the interstitial tissue of the kidney. This term is generally used for primary inflammation of KIDNEY TUBULES and/or surrounding interstitium. For primary inflammation of glomerular interstitium, see GLOMERULONEPHRITIS. Infiltration of the inflammatory cells into the interstitial compartment results in EDEMA, increased spaces between the tubules, and tubular renal dysfunction.
Definition (CSP)diffuse or local inflammation and edema of the interstitial tissue of the kidney, including the tubules.
ConceptsDisease or Syndrome (T047)
MSHD009395
EnglishIN - Interstitial nephritis, Interstitial Nephritides, interstitial nephritis, NEPHRITIS INTERSTITIAL, Renal tubulo-interstitial disease, T.I.N., Tubulointerstitial nephropathy
Spanishnefritis intersticial, nefropatia tubulointersticial
Parent ConceptsNephritis (C0027697), Connective Tissue Diseases (C0009782), Soft tissue lesion (C0410013), Morphological descriptors (C0456953), Disorder of soft tissue of body cavity (C0459146), Disorder of soft tissue of trunk (C0459151), Duplicate concept (C1274013)
SourcesCOSTAR, CSP, CST, LCH, MSH, NCI, NDFRT, OMIM, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Acute interstitial nephritis (C0149937)

ConceptsDisease or Syndrome (T047)
EnglishAcute interstitial nephritis, Acute T.I.N., Acute tubulo-interstitial nephritis, Acute tubulointerstitial disease, AIN - Acute interstitial nephritis, ATIN - Acute tubulo-interstitial nephritis, INTERSTITIAL NEPHRITIS ACUTE, NEPHRITIS INTERSTITIAL ACUTE
Spanishenfermedad tubulointersticial aguda, nefritis intersticial aguda, nefropatia tubulointersticial aguda
Parent ConceptsNephritis, Interstitial (C0027707), Acute nephritis (C0268733), Duplicate concept (C1274013)
SourcesCST, DXP, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Anal intraepithelial neoplasia (C0347129)

Definition (NCI)A precancerous neoplastic intraepithelial process involving either the squamous and transitional zones of the anal canal or the perianal skin (anal margin).
ConceptsNeoplastic Process (T191)
EnglishAIN, AIN - Anal intraepithelial neoplasia, Anal intraepithelial neoplasia, Intraepithelial Neoplasia of Anus, Intraepithelial Neoplasia of the Anus
Spanishneoplasia intraepitelial anal
Parent ConceptsAnus Neoplasms (C0003463), Gastrointestinal Intraepithelial Neoplasia (C0920207), Anal Precancerous Condition (C1332275)
SourcesNCI, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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