eMedicine Specialties > Nephrology > Tubulointerstitial Diseases of the Kidney

Nephritis, Interstitial: Follow-up

Author: A Brent Alper Jr, MD, MPH, Associate Professor of Medicine, Section of Nephrology and Hypertension, Department of Medicine, Tulane University School of Medicine
Contributor Information and Disclosures

Updated: Nov 11, 2009

Follow-up

Further Inpatient Care

  • Patients with acute renal failure or with serious electrolyte or acid-base disorders may require inpatient care until stabilization or resolution.

Further Outpatient Care

  • Provide patients with acute interstitial nephritis with follow-up care until resolution. Patients who do not recover renal function and those with chronic tubulointerstitial nephritis should receive long-term follow-up care to ensure that optimal control of blood pressure is achieved and to protect kidneys from further potentially nephrotoxic therapies and/or interventions.

Deterrence/Prevention

  • Allergic interstitial nephritis: Early recognition and prompt discontinuation of the offending drug are helpful.
  • Lead nephropathy: Implement environmental measures, such as removal of lead from indoor paint and gasoline, and eliminate other sources of exposure. Use caution with imported ceramics, particularly if glazed.

Complications

  • Hypertension may complicate any renal disease, but not all cases of interstitial renal disease are associated with hypertension (ie, Balkan endemic nephropathy, acute allergic interstitial nephritides).
  • Electrolyte and acid-base disorders may be observed.
  • Chronic tubulointerstitial disease may progress to end-stage renal disease, requiring dialysis or transplantation.

Prognosis

  • Allergic interstitial nephritis: Most patients recover renal function upon cessation of the offending agent.
  • Cholesterol microembolic kidney disease: Often, some spontaneous improvement in renal function occurs after the embolic event. Complete resolution of renal insufficiency is rare, however.
  • Chronic tubulointerstitial nephritides: Although the natural history of these diseases varies depending on the etiology, most chronic tubulointerstitial renal disease eventually progresses to end-stage renal disease. However, the rate of progression is generally believed to be much slower in tubulointerstitial nephritis compared to glomerular diseases.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Allergic interstitial nephritis: Make sure to obtain a thorough history of previously documented drug allergies before prescribing a new drug.
 
Acknowledgments

We wish to thank Suzanne Meleg-Smith, MD, for her previous contributions to this article.



More on Nephritis, Interstitial

Overview: Nephritis, Interstitial
Differential Diagnoses & Workup: Nephritis, Interstitial
Treatment & Medication: Nephritis, Interstitial
Follow-up: Nephritis, Interstitial
Multimedia: Nephritis, Interstitial
References
Further Reading
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References

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Further Reading

Related eMedicine topics:
Acute Renal Failure
Alport Syndrome [Nephrology]
Alport Syndrome [Pediatrics: General Medicine]
Goodpasture Syndrome [Nephrology]
Goodpasture Syndrome [Pediatrics: General Medicine]
Hypersensitivity Nephropathy
Lead Nephropathy
Nephritis
Nephritis, Lupus
Papillary Necrosis [Radiology]
Papillary Necrosis [Urology]
Renal Failure, Acute

Clinical guidelines:
ACR Appropriateness Criteria® renal failure. American College of Radiology - Medical Specialty Society. 1995 (revised 2008). 10 pages. NGC:007019

K/DOQI clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease. National Kidney Foundation - Disease Specific Society. 2004 May. 290 pages. NGC:003985

Clinical trials:
Abatacept and Cyclophosphamide Combination Therapy for Lupus Nephritis (ACCESS)

Etanercept for the Treatment of Lupus Nephritis

Immune System Related Kidney Disease

Study of Systemic Lupus Erythematosus

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Keywords

interstitial nephritis, nephritis, kidney disease, obstructive uropathy, acute interstitial nephritis, nephritis lupus, analgesic nephropathy, end-stage renal disease, tubulointerstitial diseases, tubulointerstitial nephritis, acute tubulointerstitial nephritis, chronic tubulointerstitial nephritis, lithium nephropathy, cyclosporine-induced nephropathy, tacrolimus-induced nephropathy, lead nephropathy, atherosclerotic kidney disease, cholesterol microembolic disease, Balkan endemic nephropathy, Chinese herb nephropathy

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Contributor Information and Disclosures

Author

A Brent Alper Jr, MD, MPH, Associate Professor of Medicine, Section of Nephrology and Hypertension, Department of Medicine, Tulane University School of Medicine
A Brent Alper Jr, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society of Hypertension, American Society of Nephrology, National Kidney Foundation, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Medical Editor

F John Gennari, MD, Associate Chair for Academic Affairs, Robert F and Genevieve B Patrick Professor, Department of Medicine, University of Vermont College of Medicine
F John Gennari, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American Federation for Medical Research, American Heart Association, American Physiological Society, American Society for Clinical Investigation, American Society of Nephrology, and International Society of Nephrology
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Ajay K Singh, MB, MRCP, MBA, Associate Professor of Medicine, Harvard Medical School; Clinical Chief, Renal Division, Director of Dialysis, Brigham and Women's Hospital; Consulting Staff, Faulkner Hospital
Disclosure: Nothing to disclose.

CME Editor

Rebecca J Schmidt, DO, FACP, FASN, Professor of Medicine, Section Chief, Department of Medicine, Section of Nephrology, West Virginia University School of Medicine
Rebecca J Schmidt, DO, FACP, FASN is a member of the following medical societies: American College of Osteopathic Internists, American College of Physicians, American Medical Association, American Society of Nephrology, International Society of Nephrology, National Kidney Foundation, Renal Physicians Association, and West Virginia State Medical Association
Disclosure: Abbott Grant/research funds Speaking and teaching; Genzyme Honoraria Consulting; Amgen Honoraria Speaking and teaching; Ortho Biotech Honoraria Speaking and teaching

Chief Editor

Vecihi Batuman, MD, FACP, FASN, Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine; Chief, Medicine Service, Southeast Louisiana Veterans Health Care System
Vecihi Batuman, MD, FACP, FASN is a member of the following medical societies: American College of Physicians, American Society of Hypertension, American Society of Nephrology, and International Society of Nephrology
Disclosure: Nothing to disclose.

 
 
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