Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- perda da função renal
- febre
- erupção cutânea
- edema
- volume de urina diminuído
Other diagnostic factors
- artralgia
- uveíte
Risk factors
- uso de medicamentos desencadeantes
- idade >65 anos
- doença inflamatória crônica
Diagnostic investigations
1st investigations to order
- ureia e creatinina séricas
- hemograma completo com diferencial de leucócitos
- urinálise
- tentativa de descontinuar o medicamento desencadeante
- anticorpo anticitoplasma de neutrófilo (ANCA)
- fator antinuclear (FAN)
- anti-DNA de fita dupla (anti-ds DNA)
- perfil complementar
Investigations to consider
- ultrassonografia renal
- biópsia renal
- exame renal com gálio
- citocinas na urina
Treatment algorithm
relacionada a medicamentos
relacionada a doença inflamatória crônica
Contributors
Authors
Mark A. Perazella, MD, FACP
Professor of Medicine (Nephrology)
Section of Nephrology
Department of Internal Medicine
Yale School of Medicine
New Haven
CT
Disclosures
MAP declares that he has no competing interests. MAP is an author of several references cited in this topic.
Dennis G. Moledina, MBBS, PhD, FASN
Assistant Professor of Medicine (Nephrology)
Department of Internal Medicine (Section of Nephrology)
Clinical and Translational Research Accelerator
Yale School of Medicine
New Haven
CT
Disclosures
DGM (via his employer Yale University) has received a grant from the National Institutes of Health and National Institute of Diabetes & Digestive & Kidney Diseases as an investigator (K23DK117065, R01DK128087, and R01DK126815). He is co-inventorof the pending patent application (number 16/536718), 'System and methods for diagnosing acute interstitial nephritis'. He serves on the board of 'Predict AIN, LLC' and has received honorarium from National Kidney Foundation. DGM is an author of several references cited in this topic.
Acknowledgements
Prof. Mark A. Perazella and Dr Dennis G. Moledina would like to gratefully acknowledge Dr James Marsh, Dr Alice Appel, Dr Gerald Appel, and Dr Kate Shiell, previous contributors to this topic.
Disclosures
JM, AA, GA, and KS declare that they have no competing interests.
Peer reviewers
Irfan Moinuddin, MD
Assistant Professor
Chicago Medical School
Rosalind Franklin University
Lombard
IL
Disclosures
IM declares that he has no competing interests.
Catherine Clase, BA, MB, MSC, FRCPC
Associate Professor
Nephrologist
McMaster University
Hamilton
Ontario
Canada
Disclosures
CC declares that she has no competing interests.
Robert Mactier, MD, FRCP
Consultant Nephrologist/Lead Clinician
Renal Unit
Glasgow Royal Infirmary
NHS Greater Glasgow and Clyde
Glasgow
UK
Disclosures
RM declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Raghavan R, Eknoyan G. Acute interstitial nephritis - a reappraisal and update. Clin Nephrol. 2014 Sep;82(3):149-62.Full text Abstract
Praga M, Sevillano A, Auñón P, et al. Changes in the aetiology, clinical presentation and management of acute interstitial nephritis, an increasingly common cause of acute kidney injury. Nephrol Dial Transplant. 2015 Sep;30(9):1472-9.Full text Abstract
Moledina DG, Eadon MT, Calderon F, et al. Development and external validation of a diagnostic model for biopsy-proven acute interstitial nephritis using electronic health record data. Nephrol Dial Transplant. 2022 Oct 19;37(11):2214-22.Full text Abstract
Moledina DG, Perazella MA. Drug-induced acute interstitial nephritis. Clin J Am Soc Nephrol. 2017 Dec 7;12(12):2046-9.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Glomerulonefrite aguda
- Necrose tubular aguda
- Lesão vascular aguda
More DifferentialsGuidelines
- Acute kidney injury: prevention, detection and management
- ACR appropriateness criteria: renal failure
More Guidelines
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