Interstitial nephritis drug-induced

Tubular and interstitial diseases (e.g., analgesic nephropathy, drug-induced nephritis, oxalate nephropathy, radiation nephritis, acute tubular necrosis, and sarcoidosis)... 

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

Two patients with long-standing ulcerative colitis developed what seemed to be a drug-induced chronic interstitial nephritis after taking sulfasalazine for several years, with no other detectable cause (73) the same problem has arisen with mesalazine. However, in a long-term stndy (mean treatment time 10 years) in 36 patients taking sulfasalazine for ulcerative cohtis, there was no nephrotoxicity (74). 

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

MagU AB. Drug-induced acute interstitial nephritis with granulomas. Hum Pathol 1983 14(1) 36-41. 

It is worth emphasizing that the same drug is capable of inducing several types of renal injury, e.g. NSAIDs may lead to intrarenal hemodynamic disturbances as well as to acute tubular necrosis, acute interstitial nephritis with or without nephrotic syndrome, and sometimes to various glomerular and arteriolar diseases [50,51]. 

Tables. Outcome of drug-induced acute interstitial nephritis with and without granulomas (modified from ref. [61]).

The classical symptoms of drug-induced hypersensitivity reactions include fever, rashes, arthralgias, eosinophilia, eosinophiluria. Hematuria, sterile pyuria, moderate proteinuria and renal failure are observed in patients with drug-induced immune tubulointerstitial nephritis (discussed in [72]). The interstitial inflammatory cells include eosinophils, lymphocytes, monocytes. 

Markowitz GS, Perazella MA Drug-induced renal failure a focus on tubulointerstitial disease. Clin Chim Acta 2005 351 31-47. Spanou Z, Keller M, Britschgi M, Yawalkar N, Fehr , Neuweiler , Gugger M, Mohaupt M, Pichler W Involvement of drug-specific cells in acute drug-induced interstitial nephritis. Am Soc Nephrol 2006 17 2919-27. 

Makino H, HaramotoT, SasakiT, Hironaka K, Shikata K,Takahashi K, Ota Z Massive eosinophilic infiltration in a patient with the nephrotic syndrome and drug-induced interstitial nephritis. Am J Kidney Dis 1995 26 62-7. 

From an epidemiological point of view, among the causes of AKI of a medical nature, drug-induced and toxic AKI are very important [77]. Nephrotoxic substances include a wide variety of compounds such as heavy metal ions, organic solvents, antibodies and natural toxins. Nephrotoxins induce AKI in humans by direct cellular toxicity, vasoconstriction, and crystal-mediated tubular obstruction. Acute interstitial inflammation is an important factor in pathogenesis of acute interstitial nephritis. In general, a decrement of... 

Josephson MA, Chiu MY, Woodle ES,Thistlethwaite JR, Haas M. Drug-induced acute interstitial nephritis in renal allografts histopathologic features and clinical course in six patients. Am J Kidney Dis. 1999 Sep 34(3) 540-8. 

The observation by Schwarz et al. [90] are germane to the influence of NSAID-induced AKI on the development of chronic renal failure. While NSAIDs accounted for only 20% of the cases of acute interstitial nephritis [90], nearly 2 out of every 3 patients from the NSAID subgroup was found to have permanent renal impairment at follow-up which represented the greatest frequency of any of the drug-induced acute interstitial nephritis. 

Rossert J, Rossert J. Drug-induced acute interstitial nephritis. Kidney International 2001 60 804-817. 

McMenamie RA, Davies LM,CrasswellOW. Drug induced interstitial nephritis, hepatitis and exfoliative dermatitis. Aust NZ J Med 1976 6 583-587. 

Peskoe ST, McMillan JH, Eorch A, Sussman H, Ozawa T. Reversible acute renal failure associated with chlorthalidone therapy possible drug induced interstitial nephritis. J Med Assoc Ga 1978 67 17-18. 

The first case of AIN associated with PPls was pubhshed in 1992 [17]. Subsequently, multiple case reports and case series have been noted in the hterature [17-32]. PPls are now considered to be the most common cause of drug-induced acute interstitial nephritis (AIN) worldwide. 

Torpey N, BarkerT, Ross C. Drug-induced tubulo-interstitial nephritis secondary to proton pump inhibitors experience from a single UK renal unit. Nephrol Dial Transplant 2004 19(6) 1441-6. 

Spanou Z, Keller M, Britschgi M, et al. Involvement of drug-specific T cells in acute drug-induced interstitial nephritis. J Am Soc Nephrol 2006 7(10) 2919-27. 

Tubulointerstitial nephritis can be either acute or chronic in nature. Acute interstitial nephritis is characterized by an acute renal interstitial inflammatory response with urinary eosinophils and nonoliguric acute renal failure. The more common drugs that induce acute interstitial nephritis include penicillins, rifampicin, sulfonamides, and cimetadine. Chronic tubulointerstitial nephritis is most commonly associated with the long term use of large amounts of analgesics and antiinflammatory agents (e.g., NSAIDs). 

Mechanisms of drug-induced kidney disease include immune-mediated toxicities (e.g., glomerulonephritis and allergic interstitial nephritis) and nonimmunologic-mediated toxicities which effect specialized characteristics of normal renal physiology. 

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