Acute interstitial nephritis due to drug hypersensitivity. An up-to-date review with a report of 19 cases.

The clinical, biologic, and pathologic features and the course and treatment of acute interstitial nephritis (AIN) due to drug hypersensitivity are reviewed. The authors report 19 additional cases of AIN, outlining some particular and unusual features. The drugs most often responsible now are penicillins and cephalosporins, cotrimoxazole, thiazide diuretics, glafenin and its derivatives, and nonsteroid anti-inflammatory agents. Diagnosis of AIN should be considered in any case of rapidly progressive renal failure occurring during drug therapy, especially when fever, skin rash, arthralgias, macroscopic hematuria, and blood or urinary eosinophilia are present. In the absence of the preceding symptoms, systematic early renal biopsy may be helpful to detect intersitial infiltrates containing lymphocytes, plasma cells, and eosinophils and/or granulomas with epithelioid cells. Immunologic tests are inconstantly positive. Their sensitivity and specificity often are doubtful in the absence of precise knowledge of the pathogenetic factors involved. Recovery may be hastened in some cases by corticoid therapy. Recurrence of the disease will be avoided by definitive suppression of offending and related drug(s).

Drug-induced granulomatous interstitial nephritis.

Among 22 cases of drug-induced acute interstitial nephritis (AIN), noncaseating interstitial granulomas were found in eight cases (36%). Acute renal failure (ARF), oliguric in three patients, appeared within 1-20 days after the beginning of therapy. Clinical symptoms suggesting a hypersensitivity reaction were unusual, marked blood eosinophilia was absent, and immunologic tests were inconstantly positive. The discovery of interstitial granulomas may be a clue to the diagnosis of drug-induced AIN, especially when the inflammatory infiltrates do not contain eosinophils. Since significant residual renal impairment may be observed the benefit of early steroid therapy must be debated.

[Use of the DIAPHANE information system for the monitoring of patients treated by home hemodialysis]. / Utilisation du système informatique DIAPHANE pour la surveillance des patients traités par hémodialyse à domicile.

Data of the DIAPHANE Dialyse-Informatique system of the Society of Nephrology have been collected by patients just on a home dialysis program after training in the hemodialysis Unit of the Hospital of Montreuil. 35 patients have been using the computerized records since January 1978. A critical analysis of the first year has been made and results obtained have been compared with those obtained during the same period in patients dialysed in the Hospital. Results show that home dialysis patients are well able to fill in the computerized medical record concerning the dialysis session follow-up, and that the quality of the recorded information is similar to that recorded in hospital by nurses. Nevertheless few simplifications of home dialysis data sheet are considered. Computerized treatment of data collected on home dialysis program should allow useful comparisons required to improve the quality of care and expansion of this dialysis method.

Thermography: an alternative to angiography for vascular access survey in haemodialysis.

Results obtained by thermography and angiography in surveying vascular access have been compared in 33 haemodialysis patients, including 23 with Cimino arteriovenous fistulae and 10 with homografts and heterografts. In 23 of 30 patients, blood flow stealing through collateral veins, or venous stenosis was detected by thermography and confirmed by angiography. Thermography seems a quick and simple method in routine conditions, restricting angiography to selected patients for whom a surgical revision of the fistula or of the graft is needed.