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Infection associated acute interstitial nephritis; a case report

BACKGROUND: Acute interstitial nephritis (AIN) is a clinico-pathological syndrome associated with a variety of infections, drugs, and sometimes with unknown causes. It is a common cause of acute kidney injury (AKI) and subsequent renal impairment, which often times is under-diagnosed. Infection-asso...

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Autores principales: Raina, Rupesh, Ale, Shirisha, Chaturvedi, Tushar, Fraley, Luke, Novak, Robert, Tanphaichitr, Natthavat
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Society of Diabetic Nephropathy Prevention 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5418070/
https://www.ncbi.nlm.nih.gov/pubmed/28491853
http://dx.doi.org/10.15171/jnp.2017.09
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author Raina, Rupesh
Ale, Shirisha
Chaturvedi, Tushar
Fraley, Luke
Novak, Robert
Tanphaichitr, Natthavat
author_facet Raina, Rupesh
Ale, Shirisha
Chaturvedi, Tushar
Fraley, Luke
Novak, Robert
Tanphaichitr, Natthavat
author_sort Raina, Rupesh
collection PubMed
description BACKGROUND: Acute interstitial nephritis (AIN) is a clinico-pathological syndrome associated with a variety of infections, drugs, and sometimes with unknown causes. It is a common cause of acute kidney injury (AKI) and subsequent renal impairment, which often times is under-diagnosed. Infection-associated AIN occurs as a consequence of many systemic bacterial, viral, and parasitic infec-tions; however, its incidence has decreased significantly after the advent of antimicrobials. Infection-associated AIN presents with both oliguric or non-oliguric renal insufficiency, without the classical clinical triad of AIN (fever, rash, and arthralgia). In this scenario the renal function is usually reversible after the infection is treated. In most cases, patients with acute renal failure present with extra-renal manifestations typically detected in underlying infections. Renal biopsy serves as the most definitive test for both the diagnosis and prognosis of AIN. CASE PRESENTATION: In this paper, we will address one such case of biopsy-proven AIN. In this case, the patient presented with severe AKI induced by anaerobic streptococcus, leading to a periodontal abscess, which was successfully treated with corticosteroids and requiring renal replacement therapy (RRT). CONCLUSIONS: AIN should be considered in the differential for unexplained AKI. Initial management should include conservative therapy by withdrawing any suspected causative agent. Renal biopsy is needed for confirmation in cases where kidney function fails to improve within 5–7 days on conservative therapy. Risk of immunosuppression is very important to consider when giving steroids in patients with infection induced AIN, and steroids may have to be delayed until the active infection is completely controlled.
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spelling pubmed-54180702017-05-10 Infection associated acute interstitial nephritis; a case report Raina, Rupesh Ale, Shirisha Chaturvedi, Tushar Fraley, Luke Novak, Robert Tanphaichitr, Natthavat J Nephropathol Case Report BACKGROUND: Acute interstitial nephritis (AIN) is a clinico-pathological syndrome associated with a variety of infections, drugs, and sometimes with unknown causes. It is a common cause of acute kidney injury (AKI) and subsequent renal impairment, which often times is under-diagnosed. Infection-associated AIN occurs as a consequence of many systemic bacterial, viral, and parasitic infec-tions; however, its incidence has decreased significantly after the advent of antimicrobials. Infection-associated AIN presents with both oliguric or non-oliguric renal insufficiency, without the classical clinical triad of AIN (fever, rash, and arthralgia). In this scenario the renal function is usually reversible after the infection is treated. In most cases, patients with acute renal failure present with extra-renal manifestations typically detected in underlying infections. Renal biopsy serves as the most definitive test for both the diagnosis and prognosis of AIN. CASE PRESENTATION: In this paper, we will address one such case of biopsy-proven AIN. In this case, the patient presented with severe AKI induced by anaerobic streptococcus, leading to a periodontal abscess, which was successfully treated with corticosteroids and requiring renal replacement therapy (RRT). CONCLUSIONS: AIN should be considered in the differential for unexplained AKI. Initial management should include conservative therapy by withdrawing any suspected causative agent. Renal biopsy is needed for confirmation in cases where kidney function fails to improve within 5–7 days on conservative therapy. Risk of immunosuppression is very important to consider when giving steroids in patients with infection induced AIN, and steroids may have to be delayed until the active infection is completely controlled. Society of Diabetic Nephropathy Prevention 2017-03 2016-10-25 /pmc/articles/PMC5418070/ /pubmed/28491853 http://dx.doi.org/10.15171/jnp.2017.09 Text en © 2017 The Author(s) Published by Society of Diabetic Nephropathy Prevention. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Raina, Rupesh
Ale, Shirisha
Chaturvedi, Tushar
Fraley, Luke
Novak, Robert
Tanphaichitr, Natthavat
Infection associated acute interstitial nephritis; a case report
title Infection associated acute interstitial nephritis; a case report
title_full Infection associated acute interstitial nephritis; a case report
title_fullStr Infection associated acute interstitial nephritis; a case report
title_full_unstemmed Infection associated acute interstitial nephritis; a case report
title_short Infection associated acute interstitial nephritis; a case report
title_sort infection associated acute interstitial nephritis; a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5418070/
https://www.ncbi.nlm.nih.gov/pubmed/28491853
http://dx.doi.org/10.15171/jnp.2017.09
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