Acute interstitial nephritis – a reappraisal and update
Acute interstitial nephritis (AIN) is an under recognized and under diagnosed cause of acute kidney injury (AKI). It is estimated to account for 15 – 20% of cases of AKI; it is the reported diagnosis in 2.8% of all kidney biopsies, and 13.5% of biopsies done specifically for acute renal failure. Con...
Autores principales: | , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Dustri-Verlag Dr. Karl Feistle
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4928030/ https://www.ncbi.nlm.nih.gov/pubmed/25079860 http://dx.doi.org/10.5414/CN108386 |
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author | Raghavan, Rajeev Eknoyan, Garabed |
author_facet | Raghavan, Rajeev Eknoyan, Garabed |
author_sort | Raghavan, Rajeev |
collection | PubMed |
description | Acute interstitial nephritis (AIN) is an under recognized and under diagnosed cause of acute kidney injury (AKI). It is estimated to account for 15 – 20% of cases of AKI; it is the reported diagnosis in 2.8% of all kidney biopsies, and 13.5% of biopsies done specifically for acute renal failure. Considerable evidence implicates antigen initiated cell-mediated injury in the pathogenesis of AIN. Drugs account for 70% of all cases, with over 150 different agents incriminated. The remaining cases are due to infections, autoimmune diseases, and rarely idiopathic. The central component of renal injury in AIN is altered tubular function, which usually precedes decrements in filtration rate. The key to early diagnosis is vigilance for the presence of tubular dysfunction in non-oliguric individuals, especially in patients with modest but gradual increments in creatinine level. The utility of urinary biomarkers to diagnose AIN in its early nascent and potentially reversible stage remains to be determined. Prompt recognition, elimination of the offending source of antigen, and use of a limited course of steroid therapy where indicated, will result in complete resolution in ~ 65% of cases, partial resolution in up to 20%, and irreversible damage in the rest. |
format | Online Article Text |
id | pubmed-4928030 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | Dustri-Verlag Dr. Karl Feistle |
record_format | MEDLINE/PubMed |
spelling | pubmed-49280302016-07-14 Acute interstitial nephritis – a reappraisal and update Raghavan, Rajeev Eknoyan, Garabed Clin Nephrol Review Article Acute interstitial nephritis (AIN) is an under recognized and under diagnosed cause of acute kidney injury (AKI). It is estimated to account for 15 – 20% of cases of AKI; it is the reported diagnosis in 2.8% of all kidney biopsies, and 13.5% of biopsies done specifically for acute renal failure. Considerable evidence implicates antigen initiated cell-mediated injury in the pathogenesis of AIN. Drugs account for 70% of all cases, with over 150 different agents incriminated. The remaining cases are due to infections, autoimmune diseases, and rarely idiopathic. The central component of renal injury in AIN is altered tubular function, which usually precedes decrements in filtration rate. The key to early diagnosis is vigilance for the presence of tubular dysfunction in non-oliguric individuals, especially in patients with modest but gradual increments in creatinine level. The utility of urinary biomarkers to diagnose AIN in its early nascent and potentially reversible stage remains to be determined. Prompt recognition, elimination of the offending source of antigen, and use of a limited course of steroid therapy where indicated, will result in complete resolution in ~ 65% of cases, partial resolution in up to 20%, and irreversible damage in the rest. Dustri-Verlag Dr. Karl Feistle 2014-09 2014-07-30 /pmc/articles/PMC4928030/ /pubmed/25079860 http://dx.doi.org/10.5414/CN108386 Text en © Dustri-Verlag Dr. K. Feistle http://creativecommons.org/licenses/by/2.5/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Review Article Raghavan, Rajeev Eknoyan, Garabed Acute interstitial nephritis – a reappraisal and update |
title | Acute interstitial nephritis – a reappraisal and update |
title_full | Acute interstitial nephritis – a reappraisal and update |
title_fullStr | Acute interstitial nephritis – a reappraisal and update |
title_full_unstemmed | Acute interstitial nephritis – a reappraisal and update |
title_short | Acute interstitial nephritis – a reappraisal and update |
title_sort | acute interstitial nephritis – a reappraisal and update |
topic | Review Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4928030/ https://www.ncbi.nlm.nih.gov/pubmed/25079860 http://dx.doi.org/10.5414/CN108386 |
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