Drug Induced Primary Tubulointerstitial Nephritis
A Retrospective Renal Biopsy Study in A Tertiary Care Hospital
DOI:
https://doi.org/10.21276/apalm.2663Keywords:
Primary tubulointerstitial nephritis, drug induced, renal biopsyAbstract
Background: Primary Tubulointerstitial Nephritis (TIN) is inflammation of predominantly tubular & interstitial compartment without involving glomeruli and vessels, which may be due to varied etiologies. Drugs are the most common culprit for Primary TIN worldwide. Here we studied a series of primary TIN in renal biopsies at a tertiary care center.
Methods: In this retrospective study of ten year duration, we have studied all cases of primary TIN with history of drug intake. We reviewed these cases for symptoms, etiology and histomorphological features.
Results: A total of 54 cases of primary TIN were described. The age range of the patients was 6 to 72 years with mean of 47.8 years. Pedal edema, puffiness of face were the most common symptoms followed by oliguria. Non-Steroidal Anti-Inflammatory (NSAIDs) were found to be the most common group of drugs causing acute TIN resulting in acute kidney injury (AKI). These are followed by antibiotics and ayurvedic/indigenous preparations. Acute TIN was more commonly seen histopathology than chronic TIN.
Conclusion: NSAIDs are most common cause of TIN followed by ayurvedic drugs. Timely diagnosis and withdrawal of offending agent with prompt treatment may help to preserve or improve renal function.
References
2. Muriithi AK, Leung N, Valeri AM, Cornell LD, Sethi S, Fidler ME, Nasr SH Am J Kidney
Dis. 2014;64(4):558-566
3. Praga M, Sevillano A, Aun~on P, Gonz alez E. Changes in the aetiology, clinical
presentation and management of acute interstitial nephritis, an increasingly common cause
of acute kidney injury. Nephrol Dial Transplant. 2015;30(9):1472-1479.
4. Praga M, Gonzalez E. Acute interstitial nephritis. Kidney Int. 2010;77(11):956-961.
5. Wilson DM, Turner DR, Cameron JS, Ogg CS, Brown CB, Chantler C. Value of renal biopsy in acute intrinsic renal failure. Br Med J 1976; 2: 459-462
6. Eknoyan G. Acute Tubulointerstitial Nephritis. In: Schrier RW (editor).Diseases of the Kidney and Urinary Tract, 7th ed. PA. Lippincott Williams & Wilkins. 2001. pp 1273-97.
7. Palmer BF, Henrich WL. Clinical acute renal failure with non-steroidal anti-inflammatory drugs. Semin Nephrol 1995; 15: 214-20.
8. Ruffing KA, Hoppes P, Blend D. Eosinophils in urine revisited. Clin Nephrol 1994; 41: 163-166.
9. Schwarz A, Krause PH, Kunzendorf U, Keller F, Distler A. The outcome of acute interstitial nephritis: risk factors for the transition from acute to chronic interstitial nephritis. Clin Nephrol.2000;54(3):179-190.
10. Clarkson MR, Giblin L, O’Connell FP, et al. Acute interstitial nephritis: clinical features and response to corticosteroid therapy. Nephrol Dial Transplant. 2004;19(11):2778-2783.
11. Gonzalez E, Gutierrez E, Galeano C, et al. Early steroid treatment improves the recovery of renal function in patients with drug-induced acute interstitial nephritis. Kidney Int. 2008;73(8):940-946.
12. Bender WL, Whelton A, Beschorner WE, Darwish MO, Hall-Craggs M, Solez K.
Interstitial nephritis, proteinuria, and renal failure caused by nonsteroidal anti-
inflammatory drugs. Am J Med 1984;76: 1006-11.
13. K. Sathe, U. Ali, A. Ohri Indian J Nephrol 2013 Jul-Aug; 23(4): 301–303
14. Nast CC Medication-Induced Interstitial Nephritis in the 21st Century. Adv Chronic Kidney Dis. 2017;24(2):72-79
15. Flynn CT, Rainford DJ, Hope E. Acute renal failure and rifampicin: Danger of unsuspected intermittent dosage. Br Med J 1974; 2: 482-5.
16. Muthukumar T, Jayakumar M, Fernando EM, Muthusethupati EM. Acute renal failure due to rifampicin: A study of 25 patients. Am J Kidney Dis. 2002; 40: 690-3.
17. Viero RM, Cavallo T. Granulomatous interstitial nephritis. Hum Pathol 1995;26:1347-50.
18. Shah S, Carter-Monroe N, Atta MG. Granulomatous interstitial nephritis. Clin Kidney J. 2015;8(5):516-523.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2019 Rojekar Amey, Madiwale Chitra
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access at http://opcit.eprints.org/oacitation-biblio.html).
