Interstitial nephritis

from Wikipedia, the free encyclopedia
Cut open kidney of a deer with punctiform hemorrhages
Acute nephritis in a deer identified by a veterinarian
Kidney with punctiform hemorrhages
Acute nephritis in a deer identified by a veterinarian.
Classification according to ICD-10
N12 Tubulointerstitial nephritis, not specified as acute or chronic
ICD-10 online (WHO version 2019)

The interstitial nephritis or tubulo-interstitial nephritis (from latin tubule "tubes, tubules ", latin interstitium "interspace" ancient Greek νεφρός nephros "kidney" and -itis for "inflammatory disease") is an inflammatory disease of the kidney in the intermediate tissue headquarters the kidney infection is. Interstitial nephritis caused by bacterial inflammation is called pyelonephritis .

frequency

Relatively rare disease, about 2–3% of all kidney biopsies and about 7–15% of all cases of acute kidney failure . The annual incidence is increasing, however.

causes

The causes are varied and include damage from toxins, drugs, viral infections, or exposure to radiation. Mostly they are noxae such as drugs (e.g. β-lactam antibiotics , aminoglycosides , nonsteroidal anti-inflammatory drugs and other pain medication , H2 antagonists , anticonvulsants and uric acid -lowering drugs), but also viral infections (e.g. hantaviruses ) and autoimmune diseases (e.g. B. Sarcoid ) can cause this disease.

pathology

Pathogenetically, there is an acutely toxic or allergic reaction. Inflammation develops primarily in the renal tubules and the adjacent interstitium with at most a low content of neutrophilic granulocytes in the inflammatory infiltrate. These infiltrates consist of lymphocytes , plasma cells , histiocytes and - in the case of allergic genesis - eosinophilic granulocytes in the tubules and in the adjacent interstitium. In drug-associated non-purulent interstitial nephritis, granulomas may also be present. In sarcoid, the granulomas are often confluent.

Symptoms

Non-specific symptoms such as fever, rash, and joint pain occur in less than 15% of cases.

laboratory

A tubular type of proteinuria is often found. The α1-microglobulin in the urine is increased.

Therapy and prognosis

An evidence-based treatment is not yet known. The most important measure is to stop the triggering noxa . Treatment with intravenous or oral corticosteroids is also an option . An attempt at therapy with mycophenolate mofetil (MMF) has recently been proposed. After removing the triggering toxin, approx. 60% of the cases heal, and chronic kidney disease develops in approx. 40% of the cases.

history

First described in 1878 by Jean-Martin Charcot in Lectures on Bright 's Disease of the Kidneys . He distinguished an acute phase, which could only be examined by means of autopsies of randomly deceased individuals, from a chronic phase, which led to death over a long period of time. Based on microscopic examinations, he concluded that the acute phase is characterized by infiltration with leukocytes , while the epithelium of the renal tubules initially appears healthy. In later stages of the disease, the tubular epithelium is expanded, damaged and embedded in fibrillary connective tissue. In 1898 William Thomas Councilman recognized acute interstitial nephritis for the first time as an independent disease, as a post-infectious complication of diphtheria and scarlet fever .

See also

literature

Individual evidence

  1. ↑ Laboratory findings in interstitial nephritis from clinics and research, 2013