Interstitial nephritis

What is interstitial nephritis?

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Interstitial (tubulointerstitial) nephritis is a disease characterized by inflammation of the interstitial tissue and renal tubules. This pathology can develop due to infection, use of certain medications, disorders of metabolism, intoxication and malignant tumors. Interstitial nephritis can occur in acute and chronic forms.

Acute interstitial nephritis is expressed by inflammatory changes in the interstitial tissue. In severe cases it causes the development of acute renal failure, but the disease usually has a favorable prognosis.

Chronic interstitial nephritis is characterized by fibrosis of the interstitial tissue, tubular atrophy and lesions of the glomeruli. The chronic form of this disease leads to nephrosclerosis and causes chronic renal failure.

Causes of interstitial nephritis

The causes of interstitial nephritis include a number of factors, including:
1) the use of drugs: antibiotics, quinolones, non-steroidal antiseptic agents, sulfonamides, diuretics (penicillin, ampicillin, cephalothin, gentamicin, ibuprofen, captopril, naproxen);
2) infectious diseases caused by bacteria (Streptococcus, diphtheria) and viruses (cytomegalovirus, hemorrhagic fever);
3) disease of the immune system (systemic lupus erythematosus);
4) multiple myeloma;
5) heavy metal poisoning (lead, mercury, cadmium);
6) metabolic disorders, etc.

When the cause of interstitial nephritis remains unknown it is called idiopathic.

The symptoms of interstitial nephritis

The clinical symptoms of interstitial nephritis depends on the degree of intoxication and the intensity of the disease.

The symptoms of acute interstitial nephritis usually occur 2-3 days after the start of various infectious diseases (tonsillitis, sore throat, flu, sinusitis) and use of antibiotics, diuretics and medicinal serums. Patients appear weakness, lethargy, loss of appetite, nausea or vomiting. Often these symptoms are accompanied by fever, muscle pain (myalgia), allergic skin rash, slight increase in blood pressure. For acute interstitial nephritis is not typical voiding and swelling.Only in very severe cases of the disease in patients decreased amount of urine (oliguria), until the complete cessation of receipt of urine in the bladder (anuria). From the first days of the disease in patients develop renal failure of varying severity, but with adequate treatment, these phenomena are completely reversible and after a couple of weeks. Concentration kidney function is usually normal in 2-3 months.

The peculiarities of the clinical picture of acute interstitial nephritis is divided into four forms:
1) its form is as follows (all expressed the clinical symptoms of the disease);
2) a severe form (expressed manifestations of acute renal failure, anuria prolonged; the patient shows acute hemodialysis);
3) the "abortive"form (no anuria favorable for rapid recovery of renal function);
4) the"focal" form (mild severity of clinical symptoms of interstitial nephritis, acute polyuria (increased urine formation), a favorable current, fast recovery).

Chronic form of interstitial nephritis has a more unfavorable course. For the later stages of the disease the characteristic changes in the functioning and structure of the glomeruli, the development of glomerulosclerosis and chronic renal failure. Among the symptoms of wave fever, allergic itchy rash, back pain, anuria or polyuria, dry mouth and thirst, increased blood pressure, anemia. The development of glomerulosclerosis leads to swelling and proteinuria. The prognosis of chronic interstitial nephritis depends on the rate of development of renal failure and renal glomeruli.

Treatment of interstitial nephritis

It is extremely important for the treatment of interstitial nephritis is the early detection and cancellation of medicines that provoke the development of disease. If possible, the number of used medicine reduce, replace nephrotoxic agents-toxic. The polyuria the amount of liquid is increased, and with oliguria – decrease. Patients with oligoanuria prescribed hemodialysis, restoring kidney function. If necessary, a short course of glucocorticoid therapy, cytotoxic agents used.

Treatment prognosis of acute interstitial nephritis is favorable; recovery occurs within a few weeks or months. The slow recovery of the renal function,prolonged anuria and defeat interstitium acute interstitial nephritis becomes chronic.

Chronic form of interstitial nephritis requires the restoration of the patient's water and electrolyte exchange; measures to address the factors of defeat interstitium, normalize functions of the urinary tract. Also, therapy aimed at the treatment of chronic renal failure.