Nephritis, interstitial

M (increased kidney weight renal tubule dilation, degeneration of renal tubule epithelium albuminous casts focal interstitial nephritis)... 

Diabetic or HIV nephropathy, analgesic abuse nephropathy, cyclosporine nephropathy, and chronic interstitial nephritis... 

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... 

The answer is b. (Hardman, p 1077.) Oxacillin is classified as a penicillinase-resistant penicillin that is relatively acid-stable and, therefore, is useful for oral administration. Major adverse reactions include penicillin hypersensitivity and interstitial nephritis. With the exception of methi-cillin, which is 35% bound to serum proteins, all penicillinase-resistant penicillins are highly bound to plasma proteins. Oxacillin has a very narrow spectrum and is used primarily as an anti staphylococcal agent... 

Non-dose-related adverse effects of sulfasalazine include rash, fever, or hepatotoxicity most commonly, as well as relatively uncommon but serious reactions such as bone marrow suppression, thrombocytopenia, pancreatitis, pneumonitis, interstitial nephritis, and hepatitis. 

Long-term lithium therapy is associated with a 10% to 20% risk of morphologic renal changes (e.g., glomerular sclerosis, tubular atrophy, and interstitial nephritis). 

Glomerulonephritis, pyelonephritis, renal infarction, papillary necrosis, renal tumors, kidney stones Pyelonephritis, interstitial nephritis... 

Drug-induced allergic interstitial nephritis, renal transplant rejection Tubular necrosis... 

Pyelonephritis, interstitial nephritis Glomerulonephritis, renal infard, lupus nephritis, vasculitis... 

Tubulointerstitial disease Acute allergic interstitial nephritis Pamidronate Nephrocalcinosis... 

Penicillins Proton pump inhibitors Chronic interstitial nephritis Cyclosporine Lithium Aristolochic acid Renal vasculitis, thrombosis, and cholesterol emboli ... 

Chronic exposure of both rats and mice resulted in tubular nephropathy in both males and females. In rats, lesions were present in 45-66% of the males when they were sacrificed at 110 weeks after receiving 212 and 423 mg/kg/day hexachloroethane for 66 weeks of a 78-week exposure period (NTP 1977 Weisburger 1977). The renal lesions were characterized by hyperchromic regenerative epithelium, necrosis, interstitial nephritis, fibrosis, focal pyelonephritis, tubular ectasis, and hyaline casts. Lesions were also present in females but had a lower incidence (18% and 59%) for the two dose groups. Two-year exposures of male rats to much lower doses (10 and 20 mg/kg/day) resulted in similar effects on the kidneys (NTP 1989). Minimal to mild nephropathy was present in females for doses of 80 and 160 mg/kg/day. Over 90% of the male and female mice exposed to 590 and 1,179 mg/kg/day hexachloroethane for 78 weeks displayed tubular nephropathy when sacrificed at 90 weeks (NTP 1977 Weisburger 1977). Regenerative tubular epithelium was visible and degeneration of the tubular epithelium occurred at the junction of the cortex and the medulla. Hyaline casts were present in the tubules, and fibrosis, calcium deposition, and inflammatory cells were noted in the kidney tissues. 

Acute-, intermediate-, and chronic-duration oral exposures of male rats to doses of 10 mg/kg/day or greater were associated with renal tubular nephropathy (Gorzinski et al. 1985 NTP 1977, 1989 Weeks et al. 1979). Affected animals displayed tubular necrosis, hyaline droplets in tubular epithelial cells, regenerative tubular epithelium, interstitial nephritis, and fibrosis. The severity of the renal lesions varied with the dose and the duration of exposure. 

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. 

Maxzide Maxzide-25 Anti hypertensive Diuretic Tab Triamterene 75 mg. hydrochlorothiazide 50 mg Tab Triamterene 37.5 mg. hydrochbrothiazide 25 mg 1 tab qd jaundice, pancreatitis, interstitial nephritis, renal stones. 1-2 tab qd... 

Voles M.pennsylvanicus) suffer renal lesions (interstitial nephritis) when fed extracts of white clover, T. repens. Milder lesions were observed after feeding on reed phalaris Phalaris arundinacea) and timothy Phleum pratense). Many varieties of reed phalaris contain the toxic compoimds gramine and tryptamine (Fig.11.15). In summer and autumn, protein levels in the leaves decrease, fiber content goes up, and secondary compoimds increase in concentration. Therefore, second growth plants have more toxic effects on voles than the spring plants that grow fast and have lower levels of secondary compounds (Bergeron etal, 1987). 

Acute cortical necrosis Drug dosing of renally cleared agents Chronic interstitial nephritis... 

The oral LDso in rats for 40% hydrogenated terphenyls (reactor coolant) was 17.5 g/kg for irradiated reactor coolant it was 6g/kg. Ingestion by mice for 16 weeks of the irradiated mixture at 1200mg/kg was lethal, whereas the nonirradiated mixture was not lethal but did cause irreversible interstitial nephritis. At 250mg/kg, no lesions were observed for tbe 16-week period of exposure. 

Eievated ANA titers Positive ANA titers have occurred. They have been reversible upon cessation of treatment and may disappear even with continued therapy. Carefully evaluate patients who develop an abnormal ANA test and, if persistent or worsening elevation of ANA titers is detected, consider discontinuing therapy. Renai/Hepatic changes Renal changes have been observed in the rat following 6 months of oral administration of propafenone at doses of 180 and 360 mg/kg/day (2 to 4 times the maximum recommended human dose). Both inflammatory and noninflammatory changes in the renal tubules with accompanying interstitial nephritis were observed. 

Renal effects Acute renal insufficiency, interstitial nephritis with hematuria, nephrotic syndrome, proteinuria, hyperkalemia, hyponatremia, renal papillary necrosis, and other renal medullary changes may occur. 

Renal function impairment Renal impairment, including minimal change nephropathy, and acute and chronic interstitial nephritis, has occurred. 

Renai Acute renal failure, dose-related increase in BUN, interstitial nephritis nephrogenic diabetes insipidus (demeclocycline). 

Adverse reactions may include the following Fever porphyria dysuria gout hepatic reaction nausea vomiting anorexia thrombocytopenia and sideroblastic anemia with erythroid hyperplasia vacuolation of erythrocytes increased serum iron concentration adverse effects on blood clotting mechanisms mild arthralgia and myalgia hypersensitivity reactions including rashes, urticaria, pruritus fever acne photosensitivity porphyria dysuria interstitial nephritis. 

Autoimmune disorders Development or exacerbation of autoimmune disorders, including myositis, hepatitis, idiopathic thrombocytopenic purpura, psoriasis, rheumatoid arthritis, interstitial nephritis, thyroiditis, and systemic lupus erythematosus have been reported in patients receiving alpha interferon. 

Uses Infxns of skin, bone, resp, urinary tract, abd, sepsis Action 4th gen PCN bactericidal X cell wall synth Dose Adults. 2-4 g IV q4-6h Peds. 200-300 mg/kg/d IV -5- q4-6h X in renal failure Caution [B, M] Contra PCN sensitivity Disp Inj SE X Pit aggregation, interstitial nephritis, renal failure, anaphylaxis, hemolytic... 

Adverse effects. Nausea, anorexia, vomiting, skin rash, diarrhea, hypersensitivity reactions including to ordinary salicylates, rarely blood dyscrasias, pancreatitis, hepatitis, interstitial nephritis. 

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