acute_interstitial_nephritis

acute_interstitial_nephritis - Tuesday Clinical Case...

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Tuesday Clinical Case conference 10/2007 Zae Kim, MD
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Acute Interstitial nephritis Term first used by Councilman in 1898 Noted the histopathologic changes in autopsy specimens of patients with diptheria and scarlet fever Immune-mediated cause of acute renal failure Characterized by presence of an inflammatory cell infiltrate in the renal interstitium and tubules there is a paucity of data in the literature regarding optimal management of the condition
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Incidence Significant cause of acute renal failure series of 109 patients from a large center biopsied for unexplained renal impairment with normal sized kidneys AIN accounted for 29 of 109 (27%) cases – Farrington K, Levison DA, Greenwood RN, Cattell WR, Baker LR. Renal biopsy in patients with unexplained renal impairment and normal kidney size. Q J Med 1989; 70: 221–233
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Causes
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The changing profile of acute tubulointerstitial nephritis Backer RJ; Pusey CD, Nephrol Dial Transplant 2004 Jan;19(1):8-11 A review of three series that totaled 128 pts (71%) Drugs, with antibiotics responsible for 1/3 (15%) Infection-related (8%) Idiopathic (5%) Tubulointerstitial nephritis and uveitis (TINU) syndrome (1%) Sarcoidosis
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Approximated frequency with which clinical manifestations occur during… (A) methicillin-induced AIN (B) AIN induced by drugs other than methicillin (C) AIN induced by NSAIDs and associated with a nephrotic syndrome http://www.nature.com/ki/journal/v60/n2/full/4492487a.html#fig2
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Epidemiology The overall picture that emerges is of a syndrome that is becoming both increasingly non-specific in clinical features diverse in etiology
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Noninvasive diagnostic procedure: eosinophiluria Number of patients 65 92 183 199 539 Patients with AIN Eosinophiluria 8 10 5 6 29 (63%) No eosinophiluria 1 1 3 9 14 Patients without AIN Eosinophiluria 27 12 15 10 64 No eosinophiluria 29 69 160 174 432 (87%) Corwin, HL, Korbet, SM, Schwartz, MM: Clinical correlates of eosinophiluria. Arch Intern Med 1985 145:1097–1099 Nolan, CR, Anger, MS, Kelleher, SP: Eosinophiluria: A new detection and definition of the clinical spectrum. N Engl J Med 1986 315:1516–1519 Corwin, HL, Bray, RA, Haber, MH: The detection and interpretation of urinary eosinophils. Arch Pathol Lab Med 1989 113:1256–1258 Ruffing, KA, Hoppes, P, Blend, D, et al : Eosinophils in urine revisited. Clin Nephrol 1994 41:163–166 http://www.nature.com/ki/journal/v60/n2/fig_tab/4492487t2.html#figure-title
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Noninvasive diagnostic procedure: Gallium scan – highly sensitive? Gallium67 scintigraphy in the diagnosis of
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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acute_interstitial_nephritis - Tuesday Clinical Case...

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