Nephrology Book

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Acute Interstitial Nephritis

Aka: Acute Interstitial Nephritis, Acute Tubulointerstitial Nephritis, Allergic Interstitial Nephritis, Interstitial Nephritis, AIN
  1. See Also
    1. Nephrotoxic Drugs
  2. Pathophysiology
    1. Renal interstitial inflammation
    2. T-Cell mediated Hypersensitivity Reaction
  3. Causes
    1. Infection
      1. Diphtheria (classic)
      2. Group A beta hemolytic Streptococcus (classic)
      3. Legionella
      4. Yersinia
      5. Staphylococcus or Streptococcus infection
      6. Mycobacterium
      7. Toxoplasmosis
      8. Mycoplasma
      9. Leptospira
      10. Rickettsia
      11. Syphilis
      12. Herpes viruses (e.g. CMV, EBV, HSV)
      13. Human Immunodeficiency Virus (HIV)
      14. Hantavirus
      15. Hepatitis C
      16. Mumps
    2. Medications (AIN occurs >2 weeks after drug started)
      1. Penicillins and Cephalosporins
        1. Hypersensitivity (fever, rash, arthralgia)
      2. Sulfonamides
        1. Vasculitis reaction
      3. NSAIDs
        1. Nephrotic Syndrome type reaction
      4. Rifampin
      5. Diuretics (Thiazides and Lasix)
      6. Allopurinol
      7. Cimetidine
      8. Ciprofloxacin
      9. Dilantin
      10. Other medications have caused AIN to a lesser extent
    3. Miscellaneous conditions
      1. Glomerulonephritis
      2. Necrotizing Vasculitis
      3. Systemic Lupus Erythematosus
      4. Acute Kidney transplant rejection
  4. Symptoms and Signs
    1. Classic triad (Methicillin induced hypersensitivity)
      1. Low grade fever (>70% of cases)
      2. Rash (>30% of cases)
      3. Arthralgia (>15% of cases)
    2. Acute Renal Failure
      1. Oliguria
      2. Malaise
      3. Nausea or Vomiting
  5. Labs: General
    1. Urinalysis
      1. Eosinophiluria
      2. Proteinuria
      3. Fractional Excretion of Sodium >1%
    2. Renal Function tests with renal insufficiency
      1. Serum Creatinine increased
      2. Blood Urea Nitrogen increased
    3. Miscellaneous
      1. Hyperchloremic Metabolic Acidosis
  6. Labs: Renal biopsy
    1. Inflammation of renal interstitium
      1. Mononuclear cell and T-Lymphocyte infiltrate
    2. Glomerular and vascular sparing
  7. Management
    1. Consider Corticosteroid course
      1. Initial: Prednisone 1 mg/kg/day PO for 2 weeks
      2. Next: Prednisone tapered off over 3-4 weeks
      3. Consider cyclophosphamide in steroid non-responders
    2. Eliminate possible causes
    3. Optimize fluid status
    4. Manage Hyperkalemia and other electrolyte abnormalities
    5. Symptomatic relief of fever and arthralgias
    6. Avoid nephrotoxic medications
  8. Prognosis
    1. Recovery in weeks if cause eliminated within 2 weeks
    2. Renal biopsy findings suggestive of poor prognosis
      1. Diffuse inflammation
      2. Neutrophils >1%
      3. Significant interstitial fibrosis
  9. Complications
    1. Acute Renal Failure (Acute Tubular Necrosis)
      1. Responsible for up to 15% of Acute Renal Failure
  10. References
    1. Kodner (2003) Am Fam Physician 67(12):2527-34
    2. Michel (1998) J Am Soc Nephrol 9:506-15

Anal intraepithelial neoplasia (C0347129)

Definition (NCI) A precancerous neoplastic intraepithelial process involving either the squamous and transitional zones of the anal canal or the perianal skin (anal margin).
Concepts Neoplastic Process (T191)
SnomedCT 255143004
Dutch anale intra-epitheliale neoplasie
French Néoplasie anale intra-épithéliale
German anale intraepitheliale Neoplasie
Italian Neoplasia intraepiteliale dell'ano
Portuguese Neoplasia intra-epitelial anal
Spanish Neoplasia anal intraepitelial, neoplasia intraepitelial anal (trastorno), neoplasia intraepitelial anal
Japanese 肛門上皮内腫瘍, ｺｳﾓﾝｼﾞｮｳﾋﾅｲｼｭﾖｳ
English AIN - Anal intraepith neoplas, anal intraepithelial neoplasia, anal intraepithelial neoplasia (diagnosis), Anal intraepithelial neoplasia, AIN - Anal intraepithelial neoplasia, Anal intraepithelial neoplasia (disorder), Intraepithelial Neoplasia of Anus, Intraepithelial Neoplasia of the Anus, Anal Intraepithelial Neoplasia, AIN
Czech Anální intraepiteliální neoplazie
Hungarian Intraepithelialis analis neoplasia
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Nephritis, Interstitial (C0027707)

Definition (CSP) diffuse or local inflammation and edema of the interstitial tissue of the kidney, including the tubules.
Definition (MSH) Inflammation of the interstitial tissue of the kidney. This term is generally used for primary inflammation of KIDNEY TUBULES and/or surrounding interstitium. For primary inflammation of glomerular interstitium, see GLOMERULONEPHRITIS. Infiltration of the inflammatory cells into the interstitial compartment results in EDEMA, increased spaces between the tubules, and tubular renal dysfunction.
Concepts Disease or Syndrome (T047)
MSH D009395
ICD10 N15.9, N10-N16.9, N10-N16, N12
SnomedCT 198506002, 264536006, 28689008
English Interstitial Nephritides, Interstitial Nephritis, Nephritides, Interstitial, Nephritis, Interstitial, NEPHRITIS INTERSTITIAL, Nephritis, interstitial, Interstitial nephritis, NOS, T.I.N., NOS, TUBULOINTERSTITIAL DISEASES, Tubulointerstitial nephropathy, NOS, Renal tubulo-interstitial dis, Renal tubulo-interstitial disease, unspecified, Renal tubulo-interstitial diseases, Interstitial renal disease or syndrome, Interstitial Renal Diseases and Syndromes, interstitial nephritis, interstitial nephritis (diagnosis), 7-124-126 TUBULOINTERSTITIAL DISEASES, Renal tubulo-interstitial disease (disorder), Nephritis interstitial, Nephritis, Interstitial [Disease/Finding], interstitial nephrities, tubulointerstitial disease, nephritis interstitial, tubulointerstitial nephropathy, disease tubulointerstitial, Renal tubulo-interstitial diseases (N10-N16), Interstitial nephritis NOS, Interstitial nephritis, Renal tubulo-interstitial disease, IN - Interstitial nephritis, Interstitial nephritis (disorder), Interstitial nephritis (qualifier value), T.I.N., Tubulointerstitial nephropathy, disease (or disorder); renal, with interstitial nephritis, disease (or disorder); tubulo-interstitial (in), renal; disease, with interstitial nephritis, tubulo-interstitial; disease
French NEPHRITE INTERSTITIELLE, Néphrite interstitielle, Néphropathie interstitielle
Portuguese NEFRITE INTERSTICIAL, Nefrite intersticial, Nefrite Intersticial
Spanish NEFRITIS INTERSTICIAL, Renal tubulo-interstitial disease, Nefritis intersticial, nefritis intersticial (calificador), nefritis intersticial (trastorno), nefritis intersticial, nefropatía tubulointersticial, Nefritis Intersticial
Swedish Nefrit, interstitiell
Czech nefritida intersticiální, Intersticiální nefritida
Finnish Interstitiaalinefriitti
Russian NEFRIT INTERSTITSIAL'NYI, TUBULOINTERSTITSIAL'NYI NEFRIT, NEFRIT TUBULOINTERSTITSIAL'NYI, INTERSTITSIAL'NYI NEFRIT, ИНТЕРСТИЦИАЛЬНЫЙ НЕФРИТ, НЕФРИТ ИНТЕРСТИЦИАЛЬНЫЙ, НЕФРИТ ТУБУЛОИНТЕРСТИЦИАЛЬНЫЙ, ТУБУЛОИНТЕРСТИЦИАЛЬНЫЙ НЕФРИТ
German NEPHRITIS INTERSTITIELL, Tubulointerstitielle Nierenkrankheit, nicht naeher bezeichnet, Nephritis interstitiell, Interstitielle Nephritis, Nephritis, interstitielle
Japanese 腎炎-尿細管間質性, 尿細管間質性腎炎, ｶﾝｼﾂｾｲｼﾞﾝｴﾝ, 腎炎-間質性, 間質性腎炎
Korean 상세불명의 세뇨관-사이질성 질환
Dutch interstitiële nefritis, aandoening; renaal, met interstitiële nefritis, aandoening; tubulo-interstitieel (bij), renaal; aandoening, met interstitiële nefritis, tubulo-interstitieel; aandoening, Tubulo-interstitiële nierziekte, niet gespecificeerd, Interstitiële nefritis, Nefritis, interstitiële
Croatian NEFRITIS, INTERSTICIJSKI
Polish Zapalenie nerek śródmiąższowe
Hungarian interstitialis nephritis
Italian Nefrite interstiziale
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Acute interstitial nephritis (C0149937)

Concepts Disease or Syndrome (T047)
ICD10 N10
SnomedCT 197672006, 28637003
English NEPHRITIS, ACUTE INTERSTITIAL, INTERSTITIAL NEPHRITIS ACUTE, NEPHRITIS INTERSTITIAL ACUTE, Acute T.I.N., NOS, Acute interstitial nephritis, NOS, Acute tubulointerstitial disease, NOS, AIN - Acute interstit nephrit, ATIN - Acute tub-interst nephr, Acute tub-interstitial nephrit, acute interstitial nephritis, acute interstitial nephritis (diagnosis), Interstitial nephritis acute, Nephritis interstitial acute, AIN - Acute interstitial nephritis, Acute interstitial nephritis, Acute tubulo-interstitial nephritis, ATIN - Acute tubulo-interstitial nephritis, Acute T.I.N., Acute interstitial nephritis (disorder), Acute tubulointerstitial disease
Spanish Acute interstitial nephritis, Nefritis aguda intersticial, Nefritis intersticial aguda, enfermedad tubulointersticial aguda, nefritis intersticial aguda (trastorno), nefritis intersticial aguda, nefropatía tubulointersticial aguda
German Akute tubulointerstitielle Nephritis, Nephritis interstitiell akut, akute interstitielle Nephritis, interstitielle Nephritis akut
Korean 급성 세뇨관-사이질성 신염
Portuguese Nefrite intersticial aguda
Dutch acute interstitiële nefritis, interstitiële nefritis acuut, Acute tubulo-interstitiële nefritis
Italian Nefrite interstiziale acuta
French Néphrite interstitielle aiguë
Czech Akutní intersticiální nefritida
Japanese 急性間質性腎炎, ｷｭｳｾｲｶﾝｼﾂｾｲｼﾞﾝｴﾝ
Hungarian Acut interstitialis nephritis
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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