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Acute Interstitial Nephritis by Krisha McCoy, MS

Definition

Acute interstitial nephritis is a kidney disorder in which the kidneys become unable to filter waste materials and fluid properly. This is a potentially serious condition that requires care from your doctor.

The Kidneys

Causes

Acute interstitial nephritis can be caused by:

Infections such as:
- Streptococcus
- Herpes
- Mumps
- Hepatitis C
- Syphilis
- HIV
Particular medications (accounts for 85% of all cases)
- Certain antibiotics
- Anti-ulcer drugs
- Nonsteroidal anti-inflammatory drugs
- Certain diuretics
Conditions that affect the immune system (eg, lupus )

Risk Factors

A risk factor is something that increases your chance for getting a disease or condition. The following risk factors increase your chance of developing acute interstitial nephritis. If you have any of these risk factors, tell your doctor:

In adults: drug / medication use
In children: infection

Symptoms

If you experience any of these symptoms do not assume it is due to acute interstitial nephritis. These symptoms may be caused by other, less serious health conditions. If you experience any one of them, see your physician.

Decrease in urine output
Blood in urine
Nausea
Vomiting
Loss of appetite
Weakness
Aching joints
Fever
Rash

Diagnosis

Your doctor will ask about your symptoms and medical history, and perform a physical exam. Tests may include the following:

Blood Tests
- BUN
- Creatinine
- Complete blood counts
- Electrolytes
- Phosphorus
- Uric acid
- Calcium
Urine tests
Kidney ultrasound
Kidney biopsy —in severe cases

Treatment

Talk with your doctor about the best treatment plan for you, which will depend on the cause of your acute interstitial nephritis. Treatment options include the following:

Medications

If medications are the cause of your interstitial nephritis, your doctor may have you stop taking medications or prescribe a different one.

Antibiotics are used to treat an infections and drugs such as corticosteroid or cyclophosphamide medications may also be used to help treat interstitial nephritis. Usually a kidney biopsy is done to confirm the diagnosis prior to starting corticosteroid or cyclophosphamide.

Dialysis

Some people with interstitial nephritis need dialysis , in which a machine does the work of your kidneys to purge waste.

Prevention

To help reduce your chances of developing acute interstitial nephritis, your doctor may suggest you avoid certain medications such as penicillin or nonsteroidal anti-inflammatory drugs.

RESOURCES:

American Academy of Family Physicians http://familydoctor.org
National Kidney Foundation http://www.kidney.org
National Kidney and Urologic Diseases Information Clearinghouse http://kidney.niddk.nih.gov

CANADIAN RESOURCES:

Canadian Institute for Health Information http://www.cihi.ca/cihiweb/dispPage.jsp?cw_page=home_e
Kidney Foundation of Canada http://www.kidney.ab.ca

References:

Acute interstitial nephritis. DynaMed website. Available at: http://dynamed101.epnet.com/Detail.aspx?style=1&docid=/dynamed/6e7085c26f45d197852562d2007562b7. Accessed December 3, 2006.
Kodner CM, Kudrimoti A. Diagnosis and management of acute interstitial nephritis. American Academy of Family Physicians website. Available at: http://www.aafp.org/afp/20030615/2527.html . Accessed December 3, 2006.
Plakoglannis R, Nogid A: Acute interstitial nephritis associated with coadministration of vancomycin and ceftriaxone: case series and review of the literature. Pharmacotherapy . 2007:27:1456-61.
Sierra F, Suzrez M, Rey M, Vela MF: Systematic review: Proton pump inhibitor-associated acute interstitial nephritis. Aliment Pharmaco Ther . 2007:26:545-53.

Last reviewed September 2009 by Adrienne Carmack, MD

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