II. Pathophysiology
- Renal interstitial inflammation
- T-Cell mediated Hypersensitivity Reaction (Allergic Reaction affecting the Kidney)
III. Causes
- See Infectious Causes of Acute Interstitial Nephritis (includes miscellaneous causes)
- Medications
- See Medication Causes of Interstitial Nephritis
- Most common causes
IV. Findings: Symptoms and Signs
- Classic Presentation of rash, fever and urine Eosinophilia in only 10% of patients (within days of starting causative medication)
- Classic Symptom Triad (e.g. Methicillin induced Hypersensitivity)
- Low grade fever (>70% of cases)
- Rash (>30% of cases)
- Arthralgia (>15% of cases)
- Acute Renal Failure
V. Labs: General
- Urinalysis
-
Renal Function tests with Renal Insufficiency
- Serum Creatinine increased
- Blood Urea Nitrogen increased
- Miscellaneous
VI. Labs: Renal biopsy
- Inflammation of renal interstitium
- Mononuclear cell and T-Lymphocyte infiltrate
- Glomerular and vascular sparing
VII. Management
- Consider Corticosteroid course
- Initial: Prednisone 1 mg/kg/day PO for 2 weeks
- Next: Prednisone tapered off over 3-4 weeks
- Consider Cyclophosphamide in steroid non-responders
- Eliminate possible causes
- Optimize fluid status
- Manage Hyperkalemia and other Electrolyte abnormalities
- Symptomatic relief of fever and Arthralgias
- Avoid nephrotoxic medications
VIII. Prognosis
- Recovery in weeks if cause eliminated within 2 weeks
- Renal biopsy findings suggestive of poor prognosis
- Diffuse inflammation
- Neutrophils >1%
- Significant interstitial fibrosis
IX. Complications
-
Acute Renal Failure
- Responsible for up to 15% of Acute Renal Failure
X. Prevention
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Definition (NCI) | A renal disorder characterized by inflammation and edema of the interstitial tissue of the kidney. |
Definition (CSP) | diffuse or local inflammation and edema of the interstitial tissue of the kidney, including the tubules. |
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. |
Concepts | Disease or Syndrome (T047) |
MSH | D009395 |
ICD10 | N15.9 , N10-N16.9, N10-N16, N12 |
SnomedCT | 198506002, 282591000009106, 264536006, 28689008 |
English | Interstitial Nephritides, Interstitial Nephritis, Nephritides, Interstitial, Nephritis, Interstitial, NEPHRITIS INTERSTITIAL, Renal tubulo-interstitial dis, Renal tubulo-interstitial disease, unspecified, Renal tubulo-interstitial diseases, interstitial nephritis, interstitial nephritis (diagnosis), Nephritis interstitial, Nephritis, Interstitial [Disease/Finding], tubulointerstitial disease, nephritis interstitial, tubulointerstitial nephropathy, disease tubulointerstitial, Renal tubulo-interstitial diseases (N10-N16), Interstitial nephritis NOS, renal tubulo-interstitial disease (diagnosis), Renal tubulo-interstitial disease (disorder), Tubulointerstitial nephropathy (disorder), Interstitial nephritis, Renal tubulo-interstitial disease, IN - Interstitial nephritis, Interstitial nephritis (disorder), Interstitial nephritis (qualifier value), T.I.N., Tubulointerstitial nephropathy, disease (or disorder); renal, with interstitial nephritis, disease (or disorder); tubulo-interstitial (in), renal; disease, with interstitial nephritis, tubulo-interstitial; disease, Interstitial nephritis, NOS, T.I.N., NOS, Tubulointerstitial nephropathy, NOS |
French | NEPHRITE INTERSTITIELLE, Néphrite interstitielle, Néphropathie interstitielle |
Portuguese | NEFRITE INTERSTICIAL, Nefrite intersticial, Nefrite Intersticial |
Spanish | NEFRITIS INTERSTICIAL, Nefritis intersticial, nefritis intersticial (calificador), nefritis intersticial (trastorno), nefritis intersticial, nefropatía tubulointersticial, Nefritis Intersticial |
Swedish | Nefrit, interstitiell |
Czech | nefritida intersticiální, Intersticiální nefritida |
Finnish | Interstitiaalinefriitti |
Russian | NEFRIT INTERSTITSIAL'NYI, TUBULOINTERSTITSIAL'NYI NEFRIT, NEFRIT TUBULOINTERSTITSIAL'NYI, INTERSTITSIAL'NYI NEFRIT, ИНТЕРСТИЦИАЛЬНЫЙ НЕФРИТ, НЕФРИТ ИНТЕРСТИЦИАЛЬНЫЙ, НЕФРИТ ТУБУЛОИНТЕРСТИЦИАЛЬНЫЙ, ТУБУЛОИНТЕРСТИЦИАЛЬНЫЙ НЕФРИТ |
German | NEPHRITIS INTERSTITIELL, Tubulointerstitielle Nierenkrankheit, nicht naeher bezeichnet, Nephritis interstitiell, Interstitielle Nephritis, Nephritis, interstitielle |
Japanese | 腎炎-尿細管間質性, 尿細管間質性腎炎, カンシツセイジンエン, 腎炎-間質性, 間質性腎炎 |
Korean | 상세불명의 세뇨관-사이질성 질환 |
Dutch | interstitiële nefritis, aandoening; renaal, met interstitiële nefritis, aandoening; tubulo-interstitieel (bij), renaal; aandoening, met interstitiële nefritis, tubulo-interstitieel; aandoening, Tubulo-interstitiële nierziekte, niet gespecificeerd, Interstitiële nefritis, Nefritis, interstitiële |
Croatian | NEFRITIS, INTERSTICIJSKI |
Polish | Zapalenie nerek śródmiąższowe |
Hungarian | interstitialis nephritis |
Norwegian | Nefritt, interstitiell, Interstitiell nefritt |
Italian | Nefrite interstiziale |
Ontology: Acute interstitial nephritis (C0149937)
Concepts | Disease or Syndrome (T047) |
ICD10 | N10 |
SnomedCT | 197672006, 28637003 |
English | AIN - Acute interstit nephrit, ATIN - Acute tub-interst nephr, Acute tub-interstitial nephrit, acute interstitial nephritis, acute interstitial nephritis (diagnosis), Interstitial nephritis acute, Nephritis interstitial acute, acute tubulo-interstitial nephritis, acute tubulo-interstitial nephritis (diagnosis), acute nephritis tubulo-interstitial, AIN - Acute interstitial nephritis, Acute interstitial nephritis, Acute tubulo-interstitial nephritis, ATIN - Acute tubulo-interstitial nephritis, Acute T.I.N., Acute interstitial nephritis (disorder), Acute tubulointerstitial disease, Acute T.I.N., NOS, Acute interstitial nephritis, NOS, Acute tubulointerstitial disease, NOS |
German | Akute tubulointerstitielle Nephritis, Nephritis interstitiell akut, akute interstitielle Nephritis, interstitielle Nephritis akut |
Korean | 급성 세뇨관-사이질성 신염 |
Spanish | Nefritis aguda intersticial, Nefritis intersticial aguda, enfermedad tubulointersticial aguda, nefritis intersticial aguda (trastorno), nefritis intersticial aguda, nefropatía tubulointersticial aguda |
Portuguese | Nefrite intersticial aguda |
Dutch | acute interstitiële nefritis, interstitiële nefritis acuut, Acute tubulo-interstitiële nefritis |
Italian | Nefrite interstiziale acuta |
French | Néphrite interstitielle aiguë |
Czech | Akutní intersticiální nefritida |
Japanese | 急性間質性腎炎, キュウセイカンシツセイジンエン |
Hungarian | Acut interstitialis nephritis |
Ontology: 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). |
Concepts | Neoplastic Process (T191) |
ICD9 | 569.44 |
ICD10 | K62.82 |
SnomedCT | 255143004, 399563001 |
Dutch | anale dysplasie, anale intra-epitheliale neoplasie |
French | Dysplasie anale, Néoplasie anale intra-épithéliale |
German | anale Dysplasie, anale intraepitheliale Neoplasie |
Italian | Displasia anale, Neoplasia intraepiteliale dell'ano |
Portuguese | Displasia anal, Neoplasia intra-epitelial anal |
Spanish | Displasia anal, Neoplasia anal intraepitelial, displasia de ano (trastorno), displasia de ano, neoplasia intraepitelial anal (trastorno), neoplasia intraepitelial anal |
Japanese | 肛門異形成, 肛門上皮内腫瘍, コウモンジョウヒナイシュヨウ, コウモンイケイセイ |
English | AIN - Anal intraepith neoplas, anal intraepithelial neoplasia, anal intraepithelial neoplasia (diagnosis), Dysplasia of anus NOS, anal dysplasia, Anal Canal and Anal Margin Squamous Intraepithelial Neoplasia, Anal Canal and Perianal Squamous Intraepithelial Neoplasia, Anal Dysplasia, dysplasia anus, dysplasia anus (diagnosis), Anal dysplasia, Anal intraepithelial neoplasia, AIN - Anal intraepithelial neoplasia, Dysplasia of anus (disorder), Dysplasia of anus, Anal intraepithelial neoplasia (disorder), Intraepithelial Neoplasia of Anus, Intraepithelial Neoplasia of the Anus, Anal Intraepithelial Neoplasia, AIN |
Czech | Anální dysplazie, Anální intraepiteliální neoplazie |
Hungarian | Analis dysplasia, Intraepithelialis analis neoplasia |