Interstitial nephritis can be asymptomatic for many years, leading to irreversible kidney damage. The development of the disease may contribute, among others, to many years of taking popular drugs, e.g. aspirin, ibuprofen, penicillin or tetracycline - an agent used to treat acne. What else are the causes of interstitial nephritis? How to recognize its symptoms? Is it always possible to recover completely?

Interstitial nephritis , also known as tubulointerstitial nephritis, is a disease in which inflammation affects the parenchyma tissue and the renal tubules, leading to an organ dysfunction.

In medical terminology, there isacute interstitial nephritis- when symptoms of inflammation appear suddenly - andchronic interstitial nephritis- when the inflammatory process lasts for a long time. In the latter case, irreversible fibrosis (scarring) of the tubulointerstitial tissue or damage to the glomeruli may occur, and in some people even kidney failure.

Interstitial nephritis - causes

In most cases (about 70%), acute interstitial nephritis is associated with the use of the so-called nephrotoxic drugs that lead to drug-induced nephropathy (drug-induced kidney damage). These include:

  • antibiotics (including the popular penicillin and tetracycline - a drug used, among others, in the treatment of acne)
  • NSAIDs (of which ibuprofen and acetylsalicylic acid are the most popular and over-the-counter medications)
  • radiological contrast agents and angiotensin converting enzyme inhibitors

These may also be anticonvulsants and diuretics. In other cases, the disease is a complication of a systemic infection (e.g. legionellosis, salmonellosis, brucellosis, cytomegalovirus infection) or another systemic disease (e.g. sarcoidosis). It happens that the doctor is unable to determine the cause of the disease. Then it is referred to as idiopathic interstitial nephritis.

The most common cause of the chronic form of the disease is:

  • years of taking medications - not just thesenephrotoxicity, although they are usually the cause of the disease. Keep in mind that virtually any drug can contribute to interstitial nephritis in people who are hypersensitive to it;
  • permanent exposure to heavy metals and / or toxic compounds. The first group is dominated by lead and cadmium, to which people working in the processing of heavy metal alloys (mainly in metallurgy and metallurgy) are exposed to excessive amounts;

The disease may also appear in the course of metabolic diseases, e.g. gout, calcium and potassium disorders, as well as immunological diseases (e.g. Sjögren's syndrome). Recurrent severe urinary tract infections and the presence of kidney stones are also risk factors.

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Interstitial nephritis - symptoms

Symptoms of acute interstitial nephritis may appear within the first few days or even 2 months after the cause (e.g. starting the drug):

  • low-grade fever or fever
  • pain in the lumbar region (described as blunt)
  • skin rash (in various locations)
  • oliguria

May also appear:

  • joint pain
  • hematuria;
  • decreased urine volume
  • other symptoms of acute kidney failure

Chronic interstitial nephritis can be asymptomatic for many years and does not cause any specific symptoms. It usually leads to chronic kidney disease, and only then does the symptoms of renal tubular dysfunction appear. This can result in glucose in the urine, loss of potassium, phosphorus, or tubular acidosis.

Interstitial nephritis - diagnosis

The first diagnostic stage is a medical interview. The patient should inform the physician about all medications taken and about possible exposure to toxins or heavy metals. Subsequently, blood tests (acute renal failure is evidenced by increased creatinine levels) and urine tests (the most common being proteinuria, increased number of erythrocytes and leukocytes). If your doctor is unable to make a definitive diagnosis based on these tests, he or she may order a kidney biopsy.

Interstitial nephritis treatment

Firsteliminate the cause of the disease, i.e. stop taking medications or avoid contact with substances that cause inflammation. If the reason is one of the above-mentioned diseases, it should be treated (e.g. if the cause of the disease are kidney stones or other obstruction in the outflow of urine, try to remove them).

Patients are also given drugs to combat inflammation. Usually these are short-term treatments with antibiotics. If the patient develops high blood pressure, antihypertensive drugs are used, and in the event of edema, diuretics are administered.

Some patients with acute renal failure requirerenal replacement therapy , usually with hemodialysis.

Interstitial nephritis - it is not always possible to heal the sick

In most cases of acute interstitial nephritis, it is possible to completely heal the patient. Unfortunately, some patients - those who struggle with the severe form of the disease - suffer from irreversible kidney damage. Then, renal replacement therapy is necessary.

There is no cure for chronic interstitial nephritis. Above treatments, such as drug discontinuation and renal replacement therapy, can only inhibit or slow down the progression of chronic kidney disease.

Category:

Urology and Nephrology