Tubulointerstitial Nephritis Medication
- Author: A Brent Alper, Jr, MD, MPH; Chief Editor: Vecihi Batuman, MD, FACP, FASN more...
For acute allergic interstitial nephritis, if no spontaneous recovery in renal function is observed after cessation of the offending agent, implementing a short course of steroid therapy is generally recommended. No controlled studies exist on the effect of corticosteroids; therefore, no well-defined dosage and duration exist. Most practitioners recommend a relatively high dose (eg, 1 mg/kg prednisone) with a rapidly tapering regimen within several weeks.
Glucocorticoid agents have immunosuppressant effects and are used for treatment of autoimmune disorders.
Prednisone has anti-inflammatory properties and causes profound and varied metabolic effects by modifying the body's immune response to diverse stimuli. This agent may decrease inflammation by reversing increased capillary permeability and suppressing polymorphonuclear lymphocyte (PMN) activity. Prednisone also stabilizes lysosomal membranes and suppresses lymphocytes and antibody production.
These agents promote the excretion of lead.
Succimer is a metal chelator, an analogue of dimercaprol that is used in lead poisoning. This agent is particularly useful in children with lead blood levels > 45 mcg/dL. Succimer is approved for chelation therapy in children for lead poisoning. However, its value in chronic lead nephropathy is not established.
Edetate is used for lead chelation; only the calcium disodium preparation should be used. In the context of this article, use of this medication is confined to testing (ie, to perform the ethylenediaminetetraacetic acid [EDTA] lead mobilization test for diagnosing lead as the etiology of chronic tubulointerstitial nephritis). Extended therapy with this agent to reduce body lead stores may be of possible benefit.
Harris RC, Neilson EG. Toward a unified theory of renal progression. Annu Rev Med. 2006. 57:365-80. [Medline].
Rangan GK, Wang Y, Tay YC, Harris DC. Inhibition of nuclear factor-kappaB activation reduces cortical tubulointerstitial injury in proteinuric rats. Kidney Int. 1999 Jul. 56(1):118-34. [Medline].
De Broe ME, Elseviers MM. Over-the-counter analgesic use. J Am Soc Nephrol. 2009 May 7. [Medline].
Slade N, Moll UM, Brdar B, et al. p53 mutations as fingerprints for aristolochic acid: an environmental carcinogen in endemic (Balkan) nephropathy. Mutat Res. 2009 Apr 26. 663(1-2):1-6. [Medline]. [Full Text].
Karmaus W, Dimitrov P, Simeonov V, et al. Offspring of parents with Balkan Endemic Nephropathy have higher C-reactive protein levels suggestive of inflammatory processes: a longitudinal study. BMC Nephrol. 2009 Apr 28. 10:10. [Medline]. [Full Text].
De Broe ME. Chinese herbs nephropathy and Balkan endemic nephropathy: toward a single entity, aristolochic acid nephropathy. Kidney Int. 2012 Mar. 81(6):513-5. [Medline].
Saeki T, Nishi S, Imai N, Ito T, Yamazaki H, Kawano M, et al. Clinicopathological characteristics of patients with IgG4-related tubulointerstitial nephritis. Kidney Int. 2010 Nov. 78(10):1016-23. [Medline].
Mackensen F, Billing H. Tubulointerstitial nephritis and uveitis syndrome. Curr Opin Ophthalmol. 2009 Sep 11. [Medline].
Border WA, Holbrook JH, Peterson MC. Gallium citrate Ga 67 scanning in acute renal failure. West J Med. 1995 May. 162(5):477-8. [Medline].
Linton AL, Richmond JM, Clark WF, Lindsay RM, Driedger AA, Lamki LM. Gallium67 scintigraphy in the diagnosis of acute renal disease. Clin Nephrol. 1985 Aug. 24(2):84-7. [Medline].
Hettinga YM, Scheerlinck LM, Lilien MR, Rothova A, de Boer JH. The Value of Measuring Urinary ß2-Microglobulin and Serum Creatinine for Detecting Tubulointerstitial Nephritis and Uveitis Syndrome in Young Patients With Uveitis. JAMA Ophthalmol. 2014 Oct 30. [Medline].
Shi Y, Su T, Qu L, Wang C, Li X, Yang L. Evaluation of urinary biomarkers for the prognosis of drug-associated chronic tubulointerstitial nephritis. Am J Med Sci. 2013 Oct. 346(4):283-8. [Medline].
Lin JL, Lin-Tan DT, Hsu KH, Yu CC. Environmental lead exposure and progression of chronic renal diseases in patients without diabetes. N Engl J Med. 2003 Jan 23. 348(4):277-86. [Medline].
Lin JL, Lin-Tan DT, Yu CC, Li YJ, Huang YY, Li KL. Environmental exposure to lead and progressive diabetic nephropathy in patients with type II diabetes. Kidney Int. 2006 Jun. 69(11):2049-56. [Medline].