Interstitial nephritis acute

Brown, muddy granular casts (highly indicative of ATN) Proteinuria (glomerulonephritis or allergic interstitial nephritis) Eosinophiluria (acute interstitial nephritis)... 

White blood cells or casts (acute interstitial nephritis or severe pyelonephritis)... 

Adverse reactions CNS Convulsions, confusion, drowsiness, myoclonus, fever Dermatologic Rash Metabolic Electrolyte imbalance Hematologic Positive Coombs test, hemolytic anemia Local Rain, thrombophlebitis Renal Acute interstitial nephritis Miscellaneous Anaphylaxis, hypersensitivity, Jarisch-Herxheimer reaction CNS Seizures, confusion, drowsiness, myoclonus, CNS stimulation Cardiovascular Myocardial depression, vasodilation, conduction disturbances Hematologic Positive Coombs test, hemolytic anemia, neutropenia Local Thrombophlebitis, sterile abscess at injection site Renal Interstitial nephritis Miscellaneous Pseudoanaphylactic reactions, hypersensitivity, Jarisch-Herxheimer reaction, serum sickness... 

Acute renal failure due to NSAIDs is usually due to prerenal causes but may be caused by acute interstitial nephritis. Usually the worsening in renal function does not depend on dose (Muhlberg and Platt 1999). Use of NSAID is thus risky and may affect the elimination of concomitant medications. 

Adverse effects that are not unequivocally related to inhibition of prostaglandin synthesis include hepatic effects (hepatitis, hepatic necrosis, cholestatic jaundice, increased serum aminotransferases), dermal effects (photosensitivities, Stevens-Johnson syndrome, toxic epidermal necrolysis, onycholysis), central nervous system (CNS) effects (headaches, dizziness, tinnitus, deafness, drowsiness, confusion, nervousness, increased sweating, aseptic meningitis), ocular effects (toxic amblyopia, retinal disturbances), and certain renal effects (acute interstitial nephritis, acute papillary necrosis). 

Severe hypersensitivity reactions, including anaphylaxis and acute interstitial nephritis occur rarely... 

The authors postulated that iodide toxicity had resulted in hemolysis and hemoglobinuria, which, together with acute interstitial nephritis secondary to inhibition of prostaglandin synthesis from mefenamic acid ingestion, had resulted in acute renal insufficiency. The mechanism of hemolysis resulting from toxic doses of iodine is not clear, although it may reflect inhibition of various red cell enzymes. 

Dysseleer A, Buysschaert M, Fonck C, Van Ginder Deuren K, Jadoul M, Tennstedt D, Cosyns JP, Daumerie C. Acute interstitial nephritis and fatal Stevens-Johnson syndrome after propylthiouracil therapy. Thyroid 2000 10(8) 713-6. 

Aspirin and similar NSAIDs can cause other toxic side effects if used improperly or if taken by patients who have preexisting diseases. For instance, serious hepato-toxicity is rare with normal therapeutic use, but high doses of aspirinlike drugs can produce adverse changes in hepatic function in patients with liver disease.85,99 Likewise, aspirin does not seem to cause renal disease in an individual with normal kidneys,84 but problems such as nephrotic syndrome, acute interstitial nephritis, and even acute renal failure have been observed when aspirin is given to patients with impaired renal function, or people with decreased body water (volume depletion).35,102... 

Nephritis All penicillins, but particularly methicillin, have the potential to cause acute interstitial nephritis. 

Neuroleptic malignant syndrome and subsequent acute interstitial nephritis has been reported in a 44-year-old woman (102). This patient met the main criteria for neuroleptic malignant syndrome, although she did not develop rigidity or a rise in creatine kinase activity. On the other hand, abnormal creatine kinase activity and signs of myotoxicity were respectively found in 14% and 2.1% of patients who took clozapine for an average of 18 months (n = 94) (103). 

Acute interstitial nephritis has been attributed to clozapine (195). 

Elias TJ, Bannister KM, Clarkson AR, Faull D, Faull RJ. Clozapine-induced acute interstitial nephritis. Lancet 1999 354(9185) 1180-1. 

Agglomeration A process of contact and adhesion whereby the particles of a dispersion form clusters of increasing size AIN Acute interstitial nephritis... 

Diekman MJ, Vlasveld LT, Krediet RT, Rankin EM, Arisz L. Acute interstitial nephritis during continuous intravenous administration of low-dose interleukin-2. Nephron 1992 60(l) 122-3. 

Vlasveld LT, van de Wiel-van Kemenade E, de Boer AJ, Sein JJ, Gallee MP, Krediet RT, Mellief CJ, Rankin EM, Hekman A, Figdor CG. Possible role for cytotoxic lymphocytes in the pathogenesis of acute interstitial nephritis after recombinant interleukin-2 treatment for renal cell cancer. Cancer Immunol Immunother 1993 36(3) 210-13. 

Frandsen NE, Saugmann S, Marcussen N. Acute interstitial nephritis associated with the use of mesalazine in inflammatory bowel disease. Nephron 2002 92(l) 200-2. 

Meys E, Devogelaer JP, Geubel A, Rahier J, Nagant de Deuxchaisnes C. Fever, hepatitis and acute interstitial nephritis in a patient with rheumatoid arthritis. Concurrent manifestations of azathioprine hypersensitivity. J Rheumatol 1992 19(5) 807-9. 

Methicillin-induced acute interstitial nephritis follows a similar pattern of dose-dependence and time-dependence to that of neutropenia (185,186). This reaction occurred in 16% of all children treated with high-dose methicillin (187). Nephritis occurred after a mean of 17 days and a mean cumulative dose of 120 g. 

With other beta-lactams, mainly penicillin G, acute interstitial nephritis is rare, but it can follow the same pattern (188). 

The underlying mechanism of a series of clinical entities associated with beta-lactams, such as maculopapular rash, drug fever, eosinophilia, serum sickness-like disease, vesicular and bullous skin reactions, erythema nodosum, and acute interstitial nephritis, is suspected to be immunological but is still largely unknown. 

Galpin JE, Shinaberger JH, Stanley TM, Blumenkrantz MJ, Bayer AS, Friedman GS, Montgomerie JZ, Guze LB, Coburn JW, Glassock RJ. Acute interstitial nephritis due to methicUUn. Am J Med 1978 65(5) 756-65. 

Murray KM, Keane WR. Review of drug-induced acute interstitial nephritis. Pharmacotherapy 1992 12(6) 462-7. 

The combination of piperacillin + tazobactam was thought to have caused acute interstitial nephritis in a 51-year-old woman (52). It remains open whether the combination or one of the components was the culprit. 

Pill MW, O Neill CV, Chapman MM, Singh AK. Suspected acute interstitial nephritis induced by piperacillin-tazobactam Pharmacotherapy 1997 17(l) 166-9. 

Cefalotin can cause two types of renal disease in man (111) acute tubular necrosis, similar to that seen with cefaloridine, although less often and acute interstitial nephritis, often accompanied by a rash, fever, or eosino-phUia, resembling the same disorder as that caused by methicillin. 

Pommer W, Krause PH, Berg PA, Neumayer HH, Mihatsch MJ, Molzahn M. Acute interstitial nephritis and non-oliguric renal failure after cefaclor treatment. Klin Wochenschr 1986 64(6) 290-3. 

Nguyen VD, Nagelberg H, Agarwal BN. Acute interstitial nephritis associated with cefotetan therapy. Am 1 Kidney Dis 1990 16(3) 259-61. 

Ladagnous JF, Rousseau JM, Gaucher A, Saissy JM, Pitti R. Nephrite interstitielle aigue role de la ceftazidime. [Acute interstitial nephritis. Role of ceftazidime.] Ann Fr Anesth Reanim 1996 15(5) 677-80. 

Whether selective COX-2 inhibitors can cause the other types of renal toxicity that are associated with non-selective NSAIDs (that is acute interstitial nephritis, nephrotic syndrome with or without renal insufficiency) is not known. 

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