II. Pathophysiology

  1. Renal interstitial inflammation
  2. T-Cell mediated Hypersensitivity Reaction (Allergic Reaction affecting the Kidney)

IV. 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

V. Labs: General

  1. Urinalysis
    1. Eosinophiluria
    2. Proteinuria
    3. Fractional Excretion of Sodium >1%
      1. Common to intrinsic Kidney disease (ATN, GN) in which Sodium cannot be retained despite decreased perfusion
  2. Renal Function tests with Renal Insufficiency
    1. Serum Creatinine increased
    2. Blood Urea Nitrogen increased
  3. Miscellaneous
    1. Hyperchloremic Metabolic Acidosis

VI. Labs: Renal biopsy

  1. Inflammation of renal interstitium
    1. Mononuclear cell and T-Lymphocyte infiltrate
  2. Glomerular and vascular sparing

VII. 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

VIII. 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

IX. Complications

  1. Acute Renal Failure
    1. Responsible for up to 15% of Acute Renal Failure

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Related Studies

Ontology: Nephritis, Interstitial (C0027707)

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
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
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