History
Patients with hypersensitivity nephropathy present with an abrupt onset of kidney dysfunction due to acute interstitial nephritis, which may occur from a few weeks to several months following exposure to the cause (eg, drugs, infection). [16, 17, 18] Fever is present in 60-100% of patients. Other signs and symptoms are much less uniform in their presentation.
Patients with tubulointerstitial nephritis-uveitis (TINU) usually present with a 2- to 3-week history of uveitis. Uveitis may precede, accompany, or follow nephritis. Most patients with TINU experience a bilateral sudden-onset anterior uveitis with typical symptoms of redness, pain, and photophobia. Patients may present with nonspecific constitutional symptoms including fever, rash, joint pain, malaise, or flank tenderness or be asymptomatic; the latter cases are detected through abnormal kidney function studies (estimated glomerular filtration rate).
Patients with acute interstitial nephritis associated with nonsteroidal anti-inflammatory drug (NSAID) use may present with signs and symptoms of nephrotic syndrome (eg, lower extremity edema, lethargy). Extrarenal signs, such as eosinophilia and rash, are less common with acute interstitial nephritis from NSAIDs than with cases from other medications.
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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Acute interstitial nephritis with mononuclear cell infiltrate.
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Mononuclear cell infiltrate between tubules.
