Advances in clinical research on drug-induced acute interstitial nephritis / 中国临床药理学与治疗学

The kidneys are one of the main excretory organs for drugs and when drugs are not excreted effectively, they can accumulate in the kidneys or in the interstitial tubules, leading to drug-induced kidney injury. The tubulointerstitium accounts for 80% of the volume of the kidney and is the primary site of response to various types of renal injury. This article focuses on drug-induced acute interstitial nephritis, highlighting its clinical symptoms, listing common induction drugs, analysing pathological features, and explaining its pathogenesis from the perspective of immune response, with the aim of providing a basic and clinical evidence for subsequent studies.

Clinical and pathological features of acute kidney injury caused by immune checkpoint inhibitors / 中国医师进修杂志

Objective:To observe and describe the clinicopathologic manifestations of acute kidney injury (AKI) caused by immune checkpoint inhibitors (ICIs).Methods:The clinicopathologic manifestations of patients diagnosed as AKI related to ICIs in Ningbo LiHuili Hospital during the period between December 2020 to December 2021 were retrospectively analyzed, including the primary tumor disease, renal pathological features, renal function progression and therapeutic effects.Results:A total of 6 patients were enrolled, all of whom were male, aged (62±11) years old. The median time from the application of ICIs to the onset of AKI was 46 d (ranging from 31 to 95 d). The median of the peak serum creatinine was 311 (205 to 1 053) μmol/L, and 1 patient received hemodialysis treatment. Six patients received renal biopsy, among which 4 cases were acute tubulointerstitial nephritis, 1 case of tubulointerstitial nephritis with both acute and chronic changes, 1 case of chronic tubulointerstitial nephritis. Of the 6 patients, 5 received glucocorticoid therapy, and 2 of the patients completely recovered, while 3 partially recovered. One patient didn′t use glucocorticoid, but his renal function was partially restored after stopping ICIs.Conclusions:AKI caused by ICIs is mainly manifested by acute tubulointerstitial nephritis. Glucocorticoid has some therapeutic effects on AKI caused by ICIs and may be an effective treatment.

Acute interstitial nephritis induced by Solanum nigrum

Acute interstitial nephritis (AIN) is an important cause of reversible acute kidney injury and pathologically characterized by inflammatory infiltrate in the renal interstitium. Solanum nigrum (S. nigrum) is a medicinal plant member of the Solanaceae family. Although S. nigrum has been traditionally used to treat various ailments such as pain, inflammation, and fever, it has also been reported to have a toxic effect, resulting in anticholinergic symptoms. However, there have been no reports of AIN caused by S. nigrum. Here, we report the first case of biopsy-confirmed AIN after ingestion of S. nigrum. The patient was successfully treated using corticosteroid therapy.

Insuficiência renal aguda secundária à sarcoidose / Acute renal failure secondary to sarcoidosis

A sarcoidose é uma doença sistêmica de etiologia desconhecida, caracterizada pela inflamação crônica granulomatosa, que acomete com maior frequencia os pulmões, a pele e os olhos e, muito raramente, detectamos envolvimento renal na patologia. relatamos aqui o caso de uma paciente de 47 anos, branca, internada em uma unidade de emergência de Hospital Universitário, devido a sintomas e achados radiológicos sugestivos de pneumonia. Desde o início da internação ela se apresentava com quadro laboratorial de insuficiência renal aguda, inicialmente atribuída ao histórico recente de uso abusivo de anti-inflamatórios. No entanto, devido à evolução arrastada e aparentemente desfavorável, inclusive com necessidade de terapia renal substitutiva (TRS), a paciente foi submetida a uma biópsia renal para esclarecimento diagnóstico e avaliação prognóstica. A descrição histológica mostrava um quadro de nefrite intersticial aguda granulomatosa, característico de sarcoidose renal, diagnóstico confirmado após revisão do prontuário médico, que revelava internação anterior devido a evento pulmonar da doença. Iniciado tratamento com prednisoma 1mg/kg/dia, a paciente evoluiu com melhora do quadro de insuficiência renal aguda, não mais necessitando de TRS. Atualmente, a paciente é mantida em acompanhamento ambulatorial com função renal estável.

The Sarcoidosis is a systemic disease of unknown etiology characterized by chronic granulomatous inflammation, which affects most frequently the lungs, skin and eyes and very rarely detected renal involvement in pathology. report here the case of a 47 year old white, admitted in an emergency unit of University Hospital because of symptoms and radiological findings suggestive of pneumonia. Since the beginning of hospitalization she performed with a laboratory diagnosis of acute renal failure, initially attributed to the recent history of abuse of anti-inflammatory drugs. However, due to unfavorable prolonged evolution and apparently, also in need of renal replacement therapy (RRT), the patient underwent renal biopsy for diagnosis and prognostic assessment. Histology showed a picture of acute interstitial nephritis, granulomatous characteristic of renal sarcoidosis, confirmed after review of medical records, which revealed previous hospitalization due to lung of the disease. Treatment with Prednisone 1mg/kg/day, the patient presented improvement of acute renal failure, no longer requiring RRT. Currently, the patient is maintained as an outpatient with stable renal function.

Clinicopathological analysis on glomerulonephritis complicating with acute interstitial nephritis / 中华肾脏病杂志

Objective To identify the clinical characteristics and pathological changes of patients suffered from glomerulonephritis complicating with acute interstitial nephritis (AIN) . Methods Twenty one patients of glomerulonephritis complicating with AIN diagnosed by renal biopsy were retrospectively analyzed . Thirty-five pure AIN patients were selected as controls .Results Glomerulonephritis complicating AIN accounted for 37 .5% of all the AIN cases . Βlactam antibiotics and Chinese herbs were the major causes of AIN . 76 .2% of cases received further examinations due to the elevation of serum creatinine (Scr) during their follow-up of kidney injuries or during routine exams for all kinds of discomforts . Pathological features of AIN were also detected besides glomerular leisions . The impairments of renal interstitia were severe than those of the glomeruli . Eosinophil in the renal interstitia was an important indicator for the diagnosis of AIN .The renal function returned to normal or baseline in 64 .7% of the patients of glomerulonephritis complicating with AIN whose follow-up data were available . The median period for renal function restoration was 150 days (compared with 60 days in pure AIN) . But there were no significant differences between these two groups as for the rate of irreversible renal insufficiency during a follow-up period of 2 years . Conclusions Symptoms of AIN in patients of glomerulonephritis complicating with AIN tend to be masked by their glomerular diseases . Renal biopsy is of most importance for the diagnosis . Early diagnosis and treatment leads to satisfactory prognosis .

Nefrite intersticial aguda após exposição a Losartan / Losartan-induced acute interstitial nephritis

Nefrite intersticial aguda é uma causa comum de perda aguda de função renal. Exposição a drogas é o fator desencadeante mais freqüentemente relatado, porém auto-imunidade e infecções também estão associadas. Os inibidores da enzima de conversão da angiotensina têm sido relatados como possíveis agentes, porém não há relato na literatura de nefrite intersticial com uso de losartan. Descrevemos o caso de perda aguda de função renal após exposição a losartan, em paciente com dano renal prévio por nefropatia diabética, cuja biópsia renal diagnosticou nefrite intersticial aguda

Acute interstitial nephritis is an important cause of acute renal failure. The majority of cases results from exposure to drugs. However imune-mediated injury and infection are common causes. The angiotensin-converting enzyme inhibitors have been implicated as possible etiologic agents, but we could not find previous data of acute intestitial nephritis associated with losartan exposure. We report a case of acute renal failure after losartan exposure, in a patient with diabetic nephropathy. The final diagnosis was confirmed by renal biopsy: acute interstitial nephritis

A Case of Aloe-nduced Acute Interstitial Nephritis / 대한신장학회잡지

We report a case of aloe induced acute interstitial nephritis in a 66-year old man. He had been taken aloe as a healthy foodstuff for 6 weeks prior to admission. He complained poor oral intake and developed nonoliguric acute renal failure. Renal biopsy revealed focal tubular atrophy and interstitial infiltration of neutrophils, and lymphocytes. After discontinuation of aloe and high dose prednisolone therapy, acute renal failure of the patient improved and serum creatinine level decreased.

A Case of Mycoplasma Pneumoniae Infection Associated Acute Interstitial Nephritis / 대한신장학회잡지

Acute interstitial nephritis is an important cause of acute renal failure and result from immune mediated tubulointerstitial injury, initiated by medications, infections, and other variable causes. Since acute interstitial nephritis may present a variety of clinical and laboratory findings and progress more rapidly than expected and it is reversible with withdrawal of the etiologic drug or administration of steroid, its early detection is very important. Mycoplasma pneumoniae is a common pathogen in young-healthy adult but mycoplasma infection induced acute interstitial nephritis is rarely reported. Therefore considering mycoplasma infection as one possible cause of acute interstitial nephritis is clinically important. So we report a case of acute interstitial nephritis associated with mycoplasma infection.

A Case of Acetaminophen-induced Acute Interstitial Nephritis Presenting with Acute Renal Failure

Acute interstital nephritis can occur by acetaminophen, but it is rarely presented as acute renal failure with azotemia. We report a case of acute interstitial nephritis induced by acetaminophen in a 14-year-old girl who developed non-oliguric acute renal failure. She has taken acetaminophen to control the persistent throat pain for the last two months. Renal biopsy revealed diffuse infiltration of mononuclear inflammatory cells admixed with eosinophils in the edematous interstitia. After the discontinuation of acetaminophen and the administration of corticosteroid, the serum creatinine level returned to normal.

A Case of Trimethoprim-Sulfamethoxazole and Omeprazole Induced Acute Interstitial Nephritis in a Patient with Renal Transplantation / 대한신장학회잡지

A 44-year-old woman diagnosed with idiopathic chronic kidney disease was subjected to living related renal transplantation from her brother. Immunosuppressant consisted of cyclosporine, mycophenolate mofetil, and prednisolone. On the day 2 after transplantation, her serum level of BUN and creatinine (Cr) were normalized to 13.4 mg/dL and 1.06 mg/dL respectively. Urine output was also well maintained. On day 9, her body temperature was 39degrees C, serum level of BUN and Cr were increased to 20.8 mg/dL and 1.54 mg/dL respectively and urine output was decreased with weight gain. Her serum cyclosporine trough level was 118 ng/dL. DTPA renal scan and Doppler sonography suggested acute rejection. So, antirejection treatment was started with methylprednisolone pulse therapy under the cover of empirical broad spectrum antibiotics. On day 11, graft biopsy was done and the biopsy was compatible with acute interstitial nephritis. The relationship between the time of renal dysfunction and drug medication was analyzed; trimethoprim-sulfamethoxazole (TMP-SMZ) and omeparzole were suspected as causative drugs. So, TMP-SMZ and omeprazole were discontinued. Her serum Cr was slowly increased to 2.32 mg/dL until day 15. And afterward, her serum Cr decreased and normalized We suggest that acute interstitial nephritis should be considered among the many causes of early renal allograft dysfunction when using TMP- SMZ and omeprazole.

A Case of Carbamazepine-induced Acute Interstitial Nephritis / 대한신장학회잡지

We report a case of acute interstitial nephritis associated with carbamazepine in a 45-year-old woman who developed acute renal failure. The patient has been taken valproic acid and carbamazepine to control the recurrent episodes of seizure after the surgery for meningioma. The patient developed acute renal failure with fever and skin rash. The patient stopped all medications except valproic acid, and was examined by ultrasonography, gallium scan and renal biopsy. Renal biopsy revealed severe interstitial infiltration of neutrophils in glomeruli without inflammation. After discontinuation of carbamazepine, acute renal failure of the patient improved and serum creatinine returned to normal.

A Case of Acyclovir Induced Acute Interstitial Nephritis / 대한신장학회잡지

Acyclovir is a remarkably safe drug with potent antiviral effect against herpes virus. The two most serious adverse effects are neurotoxicity and nephrotoxicity. We here report the case of a 64-year old woman with acyclovir induced acute interstitial nephritis. She developed non-oliguric acute renal failure following the administration of oral acyclovir(800mg five times per day) to treat herpes zoster of left 2nd and 3rd thoracic nerves. We documented a normal serum creatinine level just before exposure to the drug. On admission, serum creatinine level was 2.4 mg/dL(baseline level; 0.8mg/dL). Percutaneous renal biopsy revealed interstitial infiltration of lymphocyte and eosinophil with interstitial edema, but there was no crystal formation in the tubules or collecting ducts. After withdrawal of the acyclovir, renal function returned to normal within 1 week.

A Case of Carbamazepine-Induced Acute Interstitial Nephritis / 대한신장학회잡지

Acute interstitial nephritis is a disorder that primarily affect the renal tubule and interstitium. This disease may result from a variety of cause but drug have emerged as the most common cause of acute interstitial nephritis. Characteristically, in acute interstitial nephritis mononuclear cell infiltrate the interstitium, particularly in cortex. Diagnosis of acute intersitital nephritis can be made from historical information, physical examination,or laboratory test. But renal biopsy is the most definitive method of diagnosis. Carbamazepine has been used as a drug for treatment of convulsive disorder. This drug cause rarely renal problem. The authors experienced a case of carbamazepine induced acute interstitial nephritis in a 20 years old man who showed skin rash and mild fever, deminished renal function, and who was diagnosed by history,physical examination, renal biopsy.

A Case of Acute Interstitial Nephritis and Myoglobinuria after Alcohol Drinking / 대한신장학회잡지

Rhabdomyolysis is defined as skeletal muscle injury with release of muscle cell constituents into the plasma and may lead to acute renal failure secondary to myoglobinuria. The causes of rhabdomyolysis is diverse:alcohol abuse, primary muscle disease, disturbance of muscle metabolism, sustained seizure, infection, drugs, tox ins, trauma, severe exercise, CO intoxication etc. Rhabdomyolysis may cause acute derangement in electrolyte balance and death. It should be diagnosed earlier and managed properly. We experienced a 49 year-old woman developed acute renal failure and myoglobinuria after alcohol drinking. A kidney biopsy revealed acute interstitial nephritis. In the presence of otherwise unexplained acute renal failure in alcoholic patients, rhabdomyolysis should be considered in the differential diagnosis.

A case of acute interstitial nephritis associated with cimetidine therapy / 대한내과학회지

Although cimetidine causes a transient rise in serum creatinine without reduction of renal function, acute renal failure due to acute interstitial nephritis is rare in patients after cimetidine treatment. We here present a case of acute renal failure and acute interstitial nephritis that occurred during cimetidine treatment. A 38-year old woman was referred to our hospital because of nausea and general weakness. She had been taking cimetidine for 3 weeks because of epigasric discomfort. On admission, serum creatinine was 3.9 mg/dL and urinalysis showed mild proteinuria and hematuria. There was no history of pyelonephritis, diabetes mellitus, hypertension, toxin exposure. Renal biopsy showed severe interstitial infiltration of lymphocytes without definite glomerular change. After withdrawal of cimetidine, renal function completely recovered.

A case of acute interstitial nephritis associated with cimetidine therapy / 대한내과학회지

Although cimetidine causes a transient rise in serum creatinine without reduction of renal function, acute renal failure due to acute interstitial nephritis is rare in patients after cimetidine treatment. We here present a case of acute renal failure and acute interstitial nephritis that occurred during cimetidine treatment. A 38-year old woman was referred to our hospital because of nausea and general weakness. She had been taking cimetidine for 3 weeks because of epigasric discomfort. On admission, serum creatinine was 3.9 mg/dL and urinalysis showed mild proteinuria and hematuria. There was no history of pyelonephritis, diabetes mellitus, hypertension, toxin exposure. Renal biopsy showed severe interstitial infiltration of lymphocytes without definite glomerular change. After withdrawal of cimetidine, renal function completely recovered.

A Case of Furosemide Induced Acute Interstitial Nephritis / 대한신장학회잡지

Drug-induced acute interstitial nephritis is characterized by renal interstitial inflammatory cell infiltration and commonly presents as acute renal failure. This is caused mainly by methicillin, non-steroidal antiinflammatory drugs, sulfonamide diuretics such as thiazide, but cases induced by furosemide are rare. We report a patient with acute interstitial nephritis causing reversible acute renal failure and dermatitis while she was taking furosemide. A 37-year old woman was referred to our hospital because of generalized skin rash and non-oliguric acute renal failure. She had peripheral eosinophilia (1,577/mm3) and serum creatinine level of 6.8mg/dL. Skin biopsy showed leukoclastic vasculitis and percutaneous renal biopsy showed severe interstitial infiltration of lymph ocyte and mild interstitial fibrosis with focal tubular atrophy. After withdrawal of furosemide, renal function and skin lesions were completely recovered.

The clinical and pathological features of drug-associated acute interstitial nephritis / 中华肾脏病杂志

Objective To evaluate the clinical and pathological features of drug-associated acute interstitial nephritis. Methods Clinical presentations and pathological features were investigated in 14 patients with drug-associated acute interstitial nephritis. Lymphocyt; stimulation test was performed to confirm, the offending drugs. Results All patients presented with acute renal failure, but typical clinical features were often absent. Renal biopsy was therefore needed to establish the diagnosis. Conclusion Lymphocyte stimulation test is a very useful means in the determination of offending drugs.

Study on preventing nephrotoxic injury of amikacin / 实用儿科临床杂志

Objective To search for the methods preventing nephrotoxic injury of amikacin,Methods Case-control research was used in this study. There were 50 normal children in control group The urine routine, the ?2-microglobulin (?2 -M), mosmol and THP in urine and blood, the AIb, rGT and NAG in urine, the renal function and serum concentration of amikacin were determined respectively.The 43 patients with serious illness childten in study group, were divided into 2 groups (Group 1 and group 2 ). Group 1 (23 cases) was treated only with amikacin for 7 days, and group 2 (20 cases) was treated with vitaminC, vitamin E and amikacin for 7 days. Before treatment, the 3rd and 7th day during the treatment, all the items mentioncd above were examined in gtoup 1 and 2.Results The incidences of nephrotoxic injury of amikacin are 87 per cent (20/23)and 55 per cent (11/20) respectively in group 1 and 2. There is significant difference (P