Acute interstitial nephritis

Caused by acute inflammation of the renal interstitium, most probably mediated by a hypersensitivity reaction.

Usually triggered by an offending medication, of which >100 are known. Also occurs in chronic inflammatory disease.

Presents with acute renal failure and the 'hypersensitivity triad' of rash, fever, and eosinophilia. Nephrotic syndrome may also be present in cases triggered by non-steroidal anti-inflammatory drugs.

Usually resolves once the offending medication is discontinued.

Treatment is largely supportive, with management of fluid electrolyte balance and fluid retention. Corticosteroid therapy may be given to increase the rate and extent of renal functional recovery.

Prognosis is good, although most patients have some residual renal impairment.

Acute interstitial nephritis is a pattern of acute renal inflammation, usually triggered by medications, which is localised to the renal interstitium (the area between the tubules, glomeruli, and blood vessels).[1]Bhat P, Appel GB. Tubulointerstitial diseases. In: ACP medicine. New York, NY: WebMD Inc.; 2006:2027-2043.[2]Rossert J. Drug-induced acute interstitial nephritis. Kidney Int. 2001;60:804-817. http://www.nature.com/ki/journal/v60/n2/full/4492487a.html http://www.ncbi.nlm.nih.gov/pubmed/11473672?tool=bestpractice.com [3]Baker RJ, Pusey CD. The changing profile of acute tubulointerstitial nephritis. Nephrol Dial Transplant. 2004;19:8-11. http://ndt.oxfordjournals.org/content/19/1/8.full http://www.ncbi.nlm.nih.gov/pubmed/14671029?tool=bestpractice.com