Chronic interstitial nephritis. Treatment of chronic interstitial nephritis.

1.What is chronic interstitial nephritis and its causes?

Chronic interstitial (tubulointerstitial) nephritis, abbreviated as CIN, is a non-infectious inflammatory disease of the kidneys. In chronic interstitial nephritis, the renal tubules and interstitial tissue are affected.

Causes of chronic interstitial nephritis

The causes of CIN can be very different. Acute interstitial nephritis (AIN)—untreated or undiagnosed—can develop into chronic interstitial nephritis. However, much more often chronic interstitial nephritis appears without AIN. The causes of interstitial nephritis can be:

• Intoxication of the body;
• Radiation;
• Metabolic disorders;
• Problems with the immune system;
• Infections;
• Abuse of certain drugs (analgesics, antipyretics and non-steroidal anti-inflammatory drugs).

It is also worth mentioning that in approximately every fifth patient the cause of chronic interstitial nephritis cannot be determined.

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2. Symptoms of the disease

Symptoms of chronic interstitial nephritis are rarely pronounced, and often they are absent altogether. If CIN is caused by drug abuse, then the symptoms may not be noticeable for a long time due to the symptoms of the disease for which the drugs were taken.

Symptoms of chronic interstitial nephritis are:

• Urinary syndrome;
• Anemia;
• Arterial hypertension;
• Kidney failure.

In addition, patients with chronic interstitial nephritis note:

• Fatigue;
• Headache;
• Decreased appetite;
• Fatigue and general weakness;
• Thirst;
• Frequent urge to urinate.

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Diagnostics

Laboratory indicators are characterized by anemia, increased ESR, hyperproteinemia, hypergammaglobulinemia.

In diagnostic terms, other (extrarenal) signs of an allergic reaction are important: fever, skin rashes, arthralgia, drug-induced hepatitis, etc. However, the classic triad - fever, skin rashes and arthralgia - occurs only in 15 - 20% of cases. All of our 19 patients with acute drug-induced IN had one or another extrarenal manifestations of the disease, the most common of which was fever, observed in 2/3 of the patients, then skin syndrome, and arthralgia was much more rare. All patients had a sharp increase in ESR - up to 40 - 60 mm/h, more than half had anemia, a third had hyperproteinemia, and the vast majority had hypergammaglobulinemia.

Criteria for diagnosing acute drug-induced ID:

• temporary connection with taking medications;
• moderate urinary syndrome with proteinuria not exceeding 2 g/day, predominance of red blood cells in urine sediment;
• non-oliguric acute renal failure of varying severity, not accompanied by hyperkalemia and arterial hypertension;
• a high frequency of various tubular disorders, among which a concentration defect occurs in 100% of cases;
• protein shifts in the form of an increase in ESR, hyperproteinemia and hypergammaglobulinemia;
• anemia;
• extrarenal manifestations in the form of fever, skin syndrome, and liver damage.

4. Treatment of chronic interstitial nephritis

The first step in treating chronic interstitial nephritis is to stop taking medications that negatively affect the kidneys. With early diagnosis, this can prevent the disease, and at later stages, stop or slow down the destructive processes.

The rest of the treatment for chronic interstitial nephritis is symptomatic. Medicines and vitamins are prescribed to support kidney function. Depending on your symptoms and underlying medical conditions, dietary changes may be necessary. In severe cases, intravenous infusion of electrolytes and fluids is performed.

The main causes of illness in childhood:

• various maternal illnesses during pregnancy;
• diabetes;
• oncology;
• autoimmune processes;
• myeloma;
• vasculitis;
• acute infections;
• thrombosis;
• damage to the body by salts of heavy metals;
• self-medication with medications without specialist supervision (the use of antibiotics without appropriate prescription is especially dangerous);
• reactions to vaccines;
• hypothermia;
• tuberculosis.

Methods of treating the disease

Important! Treatment should only be carried out by a doctor who strictly controls the course of therapy. It is prohibited to try to cure a child on your own, use folk remedies, or rely on the experience of other parents.

After making a diagnosis, the doctor prescribes a special diet for the child. The child must be kept in bed and not be exposed to stress or stress.

Drug therapy is carried out using vitamin complexes and antibiotics. It can be adjusted if the expected effect is not achieved. The duration of drug treatment is usually long - up to one and a half months.

Sometimes (in the presence of toxins in the blood plasma) plasmapheresis and hemosorption (blood purification) are performed.

Any therapy requires the participation of a specialist and regular tests to monitor the progress of treatment. When the main course is completed, children are often sent to sanatoriums and physiotherapy is recommended.

Advantages of SM-Clinic

Our medical center employs some of the best specialists in the Northern capital: pediatric nephrologists, urologists, pediatricians.

“SM-Clinic” has modern equipment, thanks to which diseases are diagnosed quickly and accurately. This makes it possible to return children to normal life in a short time. We have no queues, the approach to each child is always individual and delicate. If inpatient observation is required, comfortable rooms are provided.

Sources:

1. N.I. Khlebovets. Tubulointerstitial nephritis in children // Journal of Grodno State University, 2014, No. 1, pp. 94-97.
2. Lechon FC, Espi MT, Abal RP, Peiro JLE. Acute glomerulonephritis associated with pneumonia: review of three cases. Ped. Nephrol. 2010; 25: 161-164.
3. G.A. Makovetskaya, L.I. Mazur, V.N. Barinov, E.A. Barannikova, E.M. Romadanova, P.V. Morinets. Lupus nephritis in children: manifestation, diagnosis, treatment // Russian Bulletin of Perinatology and Pediatrics, 2021, No. 62(4), pp. 185-186.

Lavrishcheva Yulia Vladimirovna Clinic

Author of the article

Lavrishcheva Yulia Vladimirovna

Doctor of the first qualification category

Specialty: nephrologist

Experience: 13 years

The information in this article is provided for reference purposes and does not replace advice from a qualified professional. Don't self-medicate! At the first signs of illness, you should consult a doctor.

FEATURES OF TUBULOINTERSTITIAL NEPHRITIS

Published in 2015, Issue April 2015, MEDICAL SCIENCES | No comments yet

Gundilovich A.K.

Student,

Belarusian State Medical University

FEATURES OF TUBULOINTERSTITIAL NEPHRITIS

annotation

The article examines the features of the course of tubulointerstitial nephritis (TIN) in patients at a nephrology hospital, identifies the main causes of TIN, the outcomes of acute tubulointerstitial nephritis under the influence of treatment, and the rate of progression of chronic tubulointerstitial nephritis from the moment of diagnosis to the start of renal replacement therapy.

Key words: tubulointerstitial nephritis, renal replacement therapy, hemodialysis.

Hundzilovich AK

Student,

Belarusian State Medical University

CLINICAL FEATURES OF TUBULOINTERSTITIAL NEPHRITIS

Abstract

The article describes clinical features of the tubulointerstitial nephritis (TIN) in patients of nephrology department, identified the main causes of the TIN, the outcome of acute tubulointerstitial nephritis (ATIN) under the influence of treatment, the rate of progression of chronic tubulointerstitial nephritis from the time of diagnosis to the start of renal replacement therapy.

Keywords: tubulointerstitial nephritis, renal replacement therapy, hemodialysis.

Tubulointerstitial nephritis (TIN) is an inflammatory lesion of the structures of the renal tubulointerstitium caused by the influence of infectious, metabolic, immune, and toxic factors; always characterized by a clinical impairment of the concentration and often filtration function of the kidneys.

According to international data, acute tubulointerstitial nephritis (ATIN) occurs in 6-9% of cases of acute kidney disease. Chronic tubulointerstitial nephritis (CTIN) is a common cause of end-stage chronic renal failure requiring renal replacement therapy.

In the Russian Federation, TIN affects 1.7% of patients who are annually prescribed treatment with program hemodialysis. Accordingly, in patients with new end-stage renal failure in the age group of 18–44 years, its frequency is 1.4%, in persons aged 45–64 years, 2.1%, in those aged 65 years and older, 2.4%.

Purpose: to study the frequency and characteristics of the course of TIN in patients at a nephrology hospital.

Tasks:

1. Assess the general structure of TIN cases.

2. Determine the causes of TIN.

3.Track the outcomes of acute TIN under the influence of treatment.

4. To clarify the rate of progression of chronic TIN from diagnosis to the start of renal replacement therapy.

Materials and research methods

A retrospective analysis of the medical records of 26 patients with a clinical diagnosis of TIN who were treated in the department of nephrology and hemodialysis of the 9th City Clinical Hospital in Minsk in the period from 2013 to 2014 was carried out.

Results and discussions

The total number of patients diagnosed with TIN in the period from 2013 to 2014 in the department of nephrology and hemodialysis of the 9th City Clinical Hospital in Minsk was 26 people, which amounted to 2.7% of all patients with renal pathology who were treated. Among them were 17 men and 9 women aged from 21 to 67 years (the average age of patients was 48.5 years). The ratio of acute TIN to chronic TIN was 11/15. 10 patients with chronic tubulointerstitial nephritis (all patients with CTIN underwent nephrobiopsy and the diagnosis was confirmed by histomorphology of the renal tissue) are on renal replacement therapy, 2 patients underwent kidney transplantation. One patient developed graft tubulointerstitial nephritis. The main causes of TIN are: medicinal (while taking NSAIDs, poisoning with alcohols and other compounds) - 30.7%, idiopathic - 30.7%, infectious - 17.6%, complication of other diseases - 11.1%, nutritional toxic genesis – 7.7%. In 9 patients with acute tubulointerstitial nephritis, the disease ended in recovery; in 2 cases, despite the therapy, the process became chronic. The rate of progression of chronic tubulointerstitial nephritis from diagnosis to the start of renal replacement therapy: on average 3.5 years. Less than a year - 40%, from 1 to 3 years - 30%, from 3 to 5 years: 10%, more than 5 years: 20%.

Conclusions:

1 The incidence of TIN is higher in men, the average age of patients was 48.5 years, 60% of patients with chronic TIN are on renal replacement therapy.

2 The main reason for the development of TIN was the use of medications (30.7%). In the same percentage of cases, the cause of the disease could not be determined. Elimination of the identified etiological factor can lead to the complete disappearance of signs of TIN.

3 Under the influence of treatment of acute TIN, recovery was noted in 9 people; in 2 cases, chronic TIN developed due to continued use of medications that caused acute TIN. Patients with TIN should be warned against self-administration of medications.

4 The rate of progression of CTIN from diagnosis to the start of renal replacement therapy: on average 3.5 years. Less than a year - 40%, from 1 to 3 years - 30%, from 3 to 5 years: 10%, more than 5 years: 20%. When diagnosing chronic TIN, it is worth considering the need to prescribe glucocorticosteroid therapy, due to the rapid rate of progression of the disease. However, the rate of irreversible deterioration of kidney function in most variants of TIN is still slower than in other chronic progressive nephropathies.

Literature

1. Nephrology. Textbook for postgraduate education / ed. E. M. Shilova. – M.: GEOTAR – Media, 2008. – 696 p.
2. Elseviers, MM High diagnostic performance of CT scan for analgesic nephropathy in patients with incipient to severe renal failure / MM Elseviers, ME De Broe // Kidney Int.-1995.-Vol.48.-P. 1316-1323
3. Clarkson, MR Acute interstitial nephritis: clinical features and response to corticosteroid therapy / MR Clarkson, L. Giblin, FP O'Connell // Nephrol. Dial. Transplant. 2004. Vol. 19. P. 2778-2783.

References

1. Nephrologia. Uchebnoe posobie dlja poslevuzovskogo obrazovanija / pod red. E.M. Shilova. – M.: GJeOTAR – Media, 2008. – 696 s.
2. Elseviers, MM High diagnostic performance of CT scan for analgesic nephropathy in patients with incipient to severe renal failure / MM Elseviers, ME De Broe // Kidney Int. -1995. – Vol. 48. – P. 1316-1323
3. Clarkson, MR Acute interstitial nephritis: clinical features and response to corticosteroid therapy / MR Clarkson, L. Giblin, FP O'Connell // Nephrol.Dial.Transplant.-2004.-Vol.19.-P.2778-2783.

Causes of chronic kidney disease (CKD)

1. Diabetes. Diabetic nephropathy is a common complication of diabetes.
2. High blood pressure. Arterial hypertension is the main cause of CKD, as well as kidney pathologies cause an increase in blood pressure, since the organ is involved in the regulation of pressure. About nine out of ten patients with CKD stages 3-5 suffer from hypertension.
3. Aging of the kidney. With age, organ function decreases. About half of people over 75 years of age have some degree of CKD.
4. Glomerulonephritis.
5. Renal artery stenosis.
6. Polycystic kidney disease.
7. Recurrent kidney infections.
8. Systemic lupus erythematosus.

Stages of CKD

1. GFR (glomerular filtration rate) shows normal kidney function (>90), signs of nephropathy are observed.
2. GFR 60-89 – moderate decrease in function against the background of identified kidney disease.
3. GFR 45–59 (3A), 30–44 (3B) – a clear decrease in renal function with or without identified pathology. For example, older patients may experience decreased function without association with a specific disease.
4. GFR 15–29 severe decline in kidney function.
5. An GFR of less than 15 is called end-stage renal disease.

Methods for preventing childhood nephritis

Parents should be aware that self-prescription of preventive medications is unacceptable. Even after an examination, only a doctor should do this.

As part of prevention, it is important to monitor the child’s lifestyle, promptly identify alarming symptoms, and conduct medical examinations in this profile. For children at risk, physical therapy, hardening, moderate physical activity, and adherence to a certain diet are recommended (consult a doctor to determine this).

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