ain - Drug induced Drug AIN Anjali Gupta History 1792...

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Drug induced Drug induced AIN AIN Anjali Gupta Anjali Gupta
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History 1792 – Admiral Jones Autopsy Specimen 1800 – Autopsy lesions referred as productive/ pyelonephritis 1898 – Councilman description of AIN 1914- Volhard included AIN in classification of renal disease 1946- More et al described lesions secondary to drugs 1953- Spuphler described analgesic nephropathy
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Histology Kidney International (2010) 77, 956–961 Diffuse vs Patchy involvement
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Etiology of AIN Kidney International (2010) 77, 956–961
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AIN AIN accounts for 7 to 15% cases of AKI. In one case series as high as 27 %. 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 In one case series only 40% of pt had a S cr <1.2 and 68% had <1.7 Kidney Int 2001
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Pathogenesis In 1974, Border et al showed that methicllin molecules acts as hapten and binds to TBM, leading to production of anti –TBM ab . N Engl J Med 1974; 291:381-384 Its now recognized it’s a T cell mediated immune reaction . Recent studies by different groups have shown that patients with drug hypersensitivity harbor drug-specific T cells in their peripheral blood and also in affected tissues.
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Drugs acting as Hapten Current Opinion in Immunology 2004, 16:732–737
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To investigate the concept that drug-specific T cells are important in the development of DIN Lymphocyte transformation test was performed in 3 pt with DIN p1 Flucloxacillin, gentamicin, rifamicin p2 azithromycin, indomethacin, pcn, van p3 diclofenanc, irbesartan, disulfiram J Am Soc Nephrol 17: 2919–2927, 2006.
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Lymphocyte Tranformation Test LTT were positive for one drug but negative for the other drugs to which the patients had been exposed .
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ain - Drug induced Drug AIN Anjali Gupta History 1792...

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