Interstitial nephritis

Interstitial inflammation with tubular damage is a regular feature of bacterial pyelonephritis but it rarely, if ever, leads to severe chronic renal damage in the absence of reflux, obstruction or other complicating factors.

Presentation may be with acute, often oliguric renal failure or more commonly as chronic slowly progressive renal disease.

Acute tubulointerstitial nephritis is most often due to a hypersensitivity reaction to drugs, most commonly drugs of the penicillin family and non-steroidal anti-inflammatory drugs (NSAIDs).

Patients present with fever, arthralgia, skin rashes and acute oliguric or non-oliguric renal failure. Many have eosinophilia and eosinophiluria. Renal biopsy shows an intense interstitial cellular infiltrate, often including eosinophils, with variable tubular necrosis.

Treatment of Interstitial nephritis

Treatment involves withdrawal of offending drugs. High-dose steroid therapy (prednisolone 60 mg daily) is commonly given but its efficacy has not been proved. Patients may require dialysis for management of the acute renal failure. Most patients have good recovery of kidney function, but some may be left with significant interstitial fibrosis.

Nephritis - Lupus Nephritis, Interstitial Nephritis, Analgesic Nephropathy

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Health Tip

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