Nephritis tubulo-interstitial

Fanconi s syndrome has also been reported (39), as have severe tubulo-interstitial nephritis (40), and acute toxic tubular necrosis (41). 

Calvino J, Romero R, Pintos E, Losada E, Novoa D, Guimil D, Mardaras J, Sanchez-Guisande D. Mesalazine-associated tubulo-interstitial nephritis in inflammatory bowel disease. Clin Nephrol 1998 49(4) 265-7. 

Robson M, Levi J, Dolberg L, Rosenfeld JB. Acute tubulo-interstitial nephritis following sulfadiazine therapy. Isr J Med Sci 1970 6(4) 561-6. 

Rashed A, Azadeh B, Abu-Romeh SH. Acyclovir-induced acute tubulo-interstitial nephritis. Nephron 1990 56 436-438. 

In recent years, however, several case reports have been published, suggesting an association between the use of 5-ASA and the development of a particular type of chronic tubulo-interstitial nephritis, characterized by an important cellular infiltration of the interstitium [26, 27]. In some cases, it was shown that this cellular infiltration was not disappearing upon arrest of the drug, even after a period of more than one year [28]. Although acute renal failure under non-steroidal antiinflammatory drugs (NSAID) is well documented, the risk for developing chronic lesions remains controversial. 

This particular form of chronic tubulo-interstitial nephritis is characterized by an important cellular infiltration of the interstitium with macrophages, T-cells but also B-cells. Furthermore, after arrest of the drug, there is improvement of the renal function in some cases [26,93]. In those in which there is a delayed diagnosis of renal damage, recovery of renal function does not occur. Instead, several of those patients needed one or another form of renal replacement therapy. An important aspect of this type of toxic nephropathy is the documented persistence of the inflammation of the renal interstitium even several months after arrest of drug intake [28]. 

The efficacy of 5-ASA as first-line treatment for IBD is clearly documented and generally accepted [115,116]. Preventive measures need to be taken into consideration however, in order to avoid nephrotoxic adverse effects. Although the incidence and risk ratio s of 5-ASA associated chronic tubulo-interstitial nephritis are not well known, the hnk established by case reports and the demonstration that recovery of renal function was observed only in patients with limited renal damage necessitates preventive measures [26]. The experience in the United Kingdom confirmed that the improvement of renal function for patients with nephrotoxicity treated for less than one year was significantly better than those on treatment for much longer [101]. 

De Broe ME, Stolear JC, Nouwen EJ, Elseviers MM. 5-Aminosalicylic acid (5-ASA) and chronic tubulo-interstitial nephritis in patients with chronic inflammatory bowel disease is there a link Nephrol Dial Transplant 1997 12 1839-1841. 

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. 

An association between the use of 5-ASA in patients with chronic inflammatory bowel disease and the development of a particular type of chronic tubulo-in-terstitial nephritis is difficult to interpret since renal involvement in chronic inflammatory bowel disease may be an extra-intestinal manifestation of the underlying disease [110]. Extra-intestinal manifestations of chronic inflammatory bowel disease are well recognized. The most frequent renal complications are oxalate stones and their consequences such as pyelonephritis, hydronephrosis and on the long-term amyloidosis [111, 112]. As for many drugs, reversible acute interstitial nephritis has been described [90]. 

Al-Refaie FN, Wickens DG, Wonke B, Kontoghiorghes GJ, Hoffbrand AV (1992) Serum non-transferrin-bound iron in beta-thalassaemia major patients treated with desferrioxamine and LI. Br J Haematol 82 431-436 Alfrey AC, Froment DH, Hammond WS (1989) Role of iron in the tubulo-interstitial injury in nephrotoxic serum nephritis. Kidney Int 36 753-759... 

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