WIDAD UNIVERSITY COLLEGE

FACULTY OF ALLIED HEALTH SCIENCES

CASE STUDY

INTERSTITIAL NEPHRITIS

POSTING DEPARTMENT: UNIT HEMODIALISIS, JABATAN

NAME: MOHAMAD RAIS BIN MOHD SHUHAIMI

MATRIC NUMBER: SP51213039

I/C NUMBER: 930427-08-5439

NO. CONTENT PAGE

1. DEFINITION 1

2. CAUSES 2

3. SIGNS & SYMPTOMS 3

4. DIAGNOSIS 3

5. MANAGEMENT 4

6. COMPLICATIONS 8

7. PROGNOSIS 9

8. REFERENCES 9
DEFINITION

Interstitial/Tubulointerstitial nephritis is a kidney condition characterized by

swelling in between the kidney tubules. The main functions of kidneys are

to filter blood and to get rid of waste from body. The kidney tubules

reabsorb water and important organic substances from kidney filtrate and

secrete substances body dont need into urine for excretion. Swelling of

these tubules can cause a number of kidney symptoms that range from

mild to severe. Interstitial nephritis can be sudden (acute) or chronic.

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 CAUSES

The following can cause interstitial nephritis:

Allergic reaction to a drug (acute interstitial allergic nephritis)

Autoimmune disorders such as anti-tubular basement membrane disease,

Kawasakis disease, Sjogren syndrome, systemic lupus erythematosus, or

Wegeners granulomatosis

Infections

Long-term use of medications such as acetaminophen (Tylenol), aspirin,

and nonsteroidal anti-inflammatory drugs (NSAIDS). This is

called analgesic nephropathy.

Side effect of certain antibiotics (including penicillin, ampicillin, methicillin,

sulfonamide medications, and others)

Side effect of other medications such as furosemide, thiazide diuretics,

omeprazole, triamterene, and allopurinol

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 SIGNS & SYMPTOMS

Interstitial nephritis can cause mild to severe kidney problems,

including acute kidney failure. In about half of cases, people will

have decreased urine output and other signs of acute kidney failure.

Symptoms of this condition may include:

Blood in the urine

Fever

Increased or decreased urine output

Mental status changes (drowsiness, confusion, coma)

Nausea, vomiting

Rash

Swelling of the body, any area

Weight gain (from retaining fluid)

DIAGNOSIS

The following blood tests are used to evaluate kidney function:

a complete blood count (CBC) level

a blood urea nitrogen (BUN) level

blood gas levels, which are used to check an acid-base imbalance in

the blood and which show the level of oxygen and carbon dioxide

Other tests that can be used to detect kidney problems include:

urinalysis

kidney ultrasound

kidney biopsy

MANAGEMENT

Management of Acute Tubulointerstitial Nephritis

In cases of acute tubulointerstitial nephritis due to hypersensitivity reactions

(allergic interstitial nephritis), early recognition and prompt discontinuation

of the offending drug are helpful; cessation of the offending agent usually,

but not always, results in complete recovery in patients. However, the rate

of recovery is variable, and, in some patients, renal failure persists for

many weeks before renal function improves. Some patients may progress

to chronic renal insufficiency.

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Obtain a thorough history of previously documented drug allergies before

prescribing a new drug.

If no sign of improvement is observed within a few days of discontinuation

of the offending agent, consider therapy with steroids. Although controlled

trials are lacking, many authors suggest using prednisone at relatively high

doses (eg, 1 mg/kg for 4-6 wks with rapid tapering of the dose). This

intervention may improve the outcome, speeding renal recovery and

reducing the requirement for dialysis.

Management of Chronic Tubulointerstitial Disease

Treatment of chronic tubulointerstitial nephritis depends on the etiology and

generally consists of supportive measures, such as adequate blood

pressure control and management of anemia.

Analgesic nephropathy

Treatment of analgesic nephropathy is supportive and also includes

discontinuation of analgesic use. Long-term follow-up studies have shown

progression to end-stage renal disease (ESRD) requiring dialysis, and

increased incidence of uroepithelial cancers is also observed in patients

with analgesic nephropathy.

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Cyclosporine/tacrolimusinduced renal failure

Reduce the cyclosporine/tacrolimus doses and target trough levels.

Discontinuing these medications and/or switching to other

immunosuppressives (eg, rapamycin), especially in those with more

advanced renal failure, should also be considered.

Lead nephropathy

Body burden of lead and bone lead concentration can be reduced by

extended chelation treatment using ethylenediaminetetraacetic acid

(EDTA) (versenate). Chelation therapy is of proven value and must be

implemented in acute lead poisoning. Although the oral chelating agent

succimer (Chemet) has proved highly successful in treating children, it has

not been widely used in adults. Nevertheless, it appears effective in

reducing body lead stores. Chelation therapy with EDTA may slow

progressive renal insufficiency in patients with mild lead intoxication.

Several studies from Taiwan have shown that chelation therapy in patients

with modest increases in body lead burden (ie, 80-600 g of lead)

significantly slowed and/or reversed the rate of decline in the glomerular

filtration rate (GFR) compared with placebo. This was found in both

diabetics and nondiabetics. However, given that these studies took place in

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Taiwan, it is difficult to generalize these results. Further study is needed

before this treatment can be recommended. Because no effective therapy

reverses the long-term consequences of lead poisoning, the best therapy is

prevention and awareness of potential environmental and occupational

sources for lead exposure. Therefore, implement environmental measures,

such as removal of lead from indoor paint and gasoline, and eliminate other

sources of exposure. Use caution with imported ceramics, particularly if

glazed. In patients with established lead nephropathy, treatment consists of

management of hypertension, gout, and chronic renal insufficiency. Many

patients with lead nephropathy progress to end-stage kidney failure and

require dialysis.

Atherosclerotic kidney disease and cholesterol microembolic disease

No specific therapy is available for atherosclerotic kidney disease, but good

control of hypertension, cessation of smoking, and vigorous control of

dyslipidemia with diet and with hepatic 3-methylglutaryl coenzyme A (HMG-

CoA) reductase inhibitors are expected to result in improved outcomes.

There is also no effective treatment available for cholesterol microembolic

disease.

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Immunoglobulin G (IgG)-4related disease

McMahon and colleagues reported a case of a 58-year-old man initially

misdiagnosed with chronic interstitial nephritis secondary to renal sarcoid

and treated with repeated doses of prednisone. After his third relapse, a

repeat renal biopsy confirmed a diagnosis of IgG4-tubulointerstitial

nephritis. The patient had become refractory to treatment with prednisone

but achieved sustained improvement in renal function after receiving

Rituximab. At 1 year post-treatment, serum creatinine remained at baseline

and a reduction in his kidney size was observed with imaging.

COMPLICATIONS

Papillary necrosis

Renal failure

Renal colic

Complications of Chronic interstitial nephritis are secondary conditions,

symptoms, or other disorders that are caused by Chronic interstitial

nephritis. In many cases the distinction between symptoms of Chronic

interstitial nephritis and complications of Chronic interstitial nephritis is

unclear or arbitrary.

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PROGNOSIS

The prognosis for interstitial nephritis depends on what type you have and

if any kidney damage was caused. In most cases, youll make a full

recovery if the allergic reaction or underlying condition is treated and no

permanent kidney damage has been caused.

REFERENCES

http://www.rightdiagnosis.com/c/chronic_interstitial_nephriti

s/complic.htm

http://www.healthline.com/health/interstitial-

nephritis#outlook7

https://familydoctor.org/condition/interstitial-nephritis/

http://emedicine.medscape.com/article/243597-overview

http://www.nytimes.com/health/guides/disease/interstitial-

nephritis/overview.html?mcubz=1