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Hypersensitivity Nephropathy Treatment & Management

  • Author: Micah L Thorp, DO, MPH; Chief Editor: Vecihi Batuman, MD, FACP, FASN  more...
 
Updated: Dec 01, 2015
 

Medical Care

Offending agents

The most important aspect of treatment is removal of the offending agents.

Occasionally, more than one agent may be causing acute interstitial nephritis (AIN). Consider the likelihood of each potential agent and substitute for each of the most likely agents (if possible).

After removing the inciting agents, administer prednisone.

Corticosteroids

If removing the inciting agents or treating the underlying infection does not improve renal function, consider corticosteroid therapy.

A retrospective study of 61 patients with biopsy-proven acute interstitial nephritis found 52 treated with corticosteroids, one half of whom showed a significant clinical improvement.[7] The study further found that delays in treatment led to decreased function.[7]

Cyclophosphamide

Cyclophosphamide therapy is controversial. This treatment causes significant short-term adverse effects in many patients, which makes many clinicians reluctant to use it in primary therapy.

Cyclophosphamide has been studied in experimental animal models of acute interstitial nephritis.

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Consultations

Consider consultation with a nephrologist in all patients thought to have acute interstitial nephritis. This is particularly important among patients whose renal function does not improve following the removal of suspected medications. Because prognosis is tied to the length of time a patient has acute interstitial nephritis, consider consultation early in the course of illness.

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Contributor Information and Disclosures
Author

Micah L Thorp, DO, MPH Consulting Staff, Department of Nephrology, Lake Road Nephrology Center, Northwest Permanente Medical Group

Micah L Thorp, DO, MPH is a member of the following medical societies: American College of Physicians, American Society of Nephrology, American Medical Association, National Kidney Foundation

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Ajay K Singh, MB, MRCP, MBA Associate Professor of Medicine, Harvard Medical School; Director of Dialysis, Renal Division, Brigham and Women's Hospital; Director, Brigham/Falkner Dialysis Unit, Faulkner Hospital

Disclosure: Nothing to disclose.

Chief Editor

Vecihi Batuman, MD, FACP, FASN Huberwald Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine; Chief, Renal Section, 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, International Society of Nephrology

Disclosure: Nothing to disclose.

Additional Contributors

Chike Magnus Nzerue, MD, FACP Professor of Medicine, Associate Dean for Clinical Affairs, Meharry Medical College

Chike Magnus Nzerue, MD, FACP is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Society of Nephrology, National Kidney Foundation

Disclosure: Nothing to disclose.

References
  1. Praga M, Sevillano A, Auñón P, González E. Changes in the aetiology, clinical presentation and management of acute interstitial nephritis, an increasingly common cause of acute kidney injury. Nephrol Dial Transplant. 2015 Sep. 30 (9):1472-9. [Medline].

  2. Burkhart R, Shah N, Lewin M. Sildenafil Induced Acute Interstitial Nephritis. Case Rep Nephrol. 2015. 2015:731284. [Medline].

  3. Chan SY, Cheung CY, Chan PT, Chau KF. Clozapine-induced acute interstitial nephritis. Hong Kong Med J. 2015 Aug. 21 (4):372-4. [Medline].

  4. Cheungpasitporn W, Leung N, Rajkumar SV, Cornell LD, Sethi S, Angioi A, et al. Bortezomib-induced acute interstitial nephritis. Nephrol Dial Transplant. 2015 Jul. 30 (7):1225-9. [Medline].

  5. Ferluga D, Vizjak A. Hantavirus nephropathy. J Am Soc Nephrol. 2008 Sep. 19(9):1653-8. [Medline]. [Full Text].

  6. Wyatt CM, Morgello S, Katz-Malamed R, Wei C, Klotman ME, Klotman PE. The spectrum of kidney disease in patients with AIDS in the era of antiretroviral therapy. Kidney Int. 2009 Feb. 75(4):428-34. [Medline].

  7. Gonzalez E, Gutierrez E, Galeano C, et al. Early steroid treatment improves the recovery of renal function in patients with drug-induced acute interstitial nephritis. Kidney Int. 2008 Apr. 73(8):940-6. [Medline].

  8. Alpers CE. The evolving contribution of renal pathology to understanding interstitial nephritis. Ren Fail. 1998 Nov. 20(6):763-71. [Medline].

  9. Councilman WT. Acute interstitial nephritis. Journal of Experimental Medicine. 1898. 3:393-420.

  10. Fried T. Acute interstitial nephritis. Why do the kidneys suddenly fail?. Postgrad Med. 1993 Apr. 93(5):105-6, 111-2, 117-20. [Medline].

  11. Kleinknecht D. Interstitial nephritis, the nephrotic syndrome, and chronic renal failure secondary to nonsteroidal anti-inflammatory drugs. Semin Nephrol. 1995 May. 15(3):228-35. [Medline].

  12. Michel DM, Kelly CJ. Acute interstitial nephritis. J Am Soc Nephrol. 1998 Mar. 9(3):506-15. [Medline].

  13. Reddy S, Salant DJ. Treatment of acute interstitial nephritis. Ren Fail. 1998 Nov. 20(6):829-38. [Medline].

  14. Ruffing KA, Hoppes P, Blend D, et al. Eosinophils in urine revisited. Clin Nephrol. 1994 Mar. 41(3):163-6. [Medline].

 
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Acute interstitial nephritis with mononuclear cell infiltrate.
Mononuclear cell infiltrate between tubules.
 
 
 
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