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...

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Autores principales: Raghavan, Rajeev, Eknoyan, Garabed
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dustri-Verlag Dr. Karl Feistle 2014
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
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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.
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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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