Hypersensitivity Nephropathy Clinical Presentation

Updated: Sep 17, 2019
  • Author: Micah L Thorp, DO, MPH; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Presentation

History

Patients invariably present with an abrupt onset of renal dysfunction. Patients with other symptoms are much less uniform in their presentation.  Recent etiological exposure (eg, drugs, infection) can cause acute interstitial nephritis at any time following exposure, from a few weeks to several months later. [11, 12, 13]  Fever is present in 60-100% of patients.

Patients with tubulointerstitial nephritis-uveitis (TINU) usually present with a 2- to 3-week history of uveitis. Uveitis may precede nephritis, occur subsequent to nephritis, or occur simultaneous with nephritis. Most patients with TINU experience a bilateral sudden-onset anterior uveitis which presents with typical symptoms of redness, pain and photophobia. Patients may present with non-specific constitutional symptoms including fever, rash, joint pain, malaise or flank tenderness or be asymptomatic and detected through abnormal renal function (estimated GFR) tests. A proportion of patients develop peripheral blood eosinophilia but this is in an inconsistent feature. [9]  

Patients with NSAID-associated acute interstitial nephritis have a history of NSAID use, and symptoms of nephrotic syndrome may be present (eg, lower extremity edema, lethargy). When NSAIDs lead to acute interstitial nephritis, patients often present with nephrotic-range proteinuria. Extrarenal signs, such as eosinophilia and rash, are less common with NSAIDs than with other medications.

 

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Physical

Frequently, nothing unusual is discovered on physical examination. The two most common findings are rash and fever. The rash is frequently described as maculopapular, although, in allopurinol-related acute interstitial nephritis, it is sometimes exfoliative. Fever is present in 60-100% of cases.

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