Acute Interstitial Nephritis

Question 1

characteristic finding on biopsy that indicates AIN

Answer 1

white blood cells in kidney biopsy

Question 2

which one is the normal biopsy and which one was the acute interstitial nephritis biopsy

Answer 2

Question 3

cause of injury in AIN:

___ blood cells go into the interstitium and cause inflammation. This mechanism of __ __ involves T cells and __ infiltrating the interstitial compartment. by definition, there should be no antibodies seen in this injury.

Answer 3

WHITE blood cells go into the interstitium and cause inflammation. This mechanism of CELLULAR IMMUNITY involves T cells and MONOCYTES infiltrating the interstitial compartment. by definition, there should be no antibodies seen in this injury.

Question 4

T/F you would see antibodies in a bipsy of someone with AIN

Answer 4

false. you would see T cells and monocytes, but no antibodies

Question 5

Broad causes of AIN

Answer 5

drugs

infections

AI disorders

tubular obstruction

idiopathic

Question 6

most common cause of AIN

Answer 6

drugs. NSAIDS and Antibiotics. causes 70% of cases. this is due to allergic immune activation and is dose independent.

Question 7

T/F if. you overdose on NSAIDS, you will get AIN

Answer 7

false. drug induced AIN this is due to allergic immune activation and is dose independent.

Question 8

common bacteria causes of AIN

Answer 8

streptococcus

legionella

leptospirosis

Question 9

common viral causes of AIN

Answer 9

– if youre immunocompromised

• EBV, CMV or polyoma viruses (in any person, but mainyl IC)

Question 10

autoimmune diseases cause 5% of cases of AIN. What diseases are they?

Answer 10

1. lupus
2. sjogren
3. sarcoidosis
   - can be confined to the kidney

Question 11

Tubular obstruction is rarely a cause of AIN, but if it does happen, what usually is seen on labs and U/S as causes?

Answer 11

• cast nephropathy in multiple myeloma
• uric acid nephropathy tumor lysis syndrome
• calcium oxalate deposition - ethylene glycol toxicity

Question 12

Physical exam findings Trio that should make you have a “high index of suspicion” for AIN

Answer 12

• rash
• fever
• eosinophilia
• only 10% have all three.

Question 13

__ ___ ___ casts are pathognomonic. You may also see___uria, urine ___, and tubular dysfunction resulting in renal tubular ____. A ___ ____ is usually required for actual diagnosis.

Answer 13

White Blood Cell casts are pathognomonic. You may also see pyuria, urine eosinophils, and tubular dysfunction resulting in renal tubular acidosis. A Kidney Biopsy is usually required for actual diagnosis.

May also see an electrolyte disorder

Question 14

General Treatment:

• Treat the __ __
• For drug induced AIN, consider __ Prognosis is dependent on the __
• Most recover, but __ is common

Answer 14

General Treatment:

Treat the underlying condition

For drug induced AIN, consider corticosteroids Prognosis is dependent on the cause
Most recover, but CKD is common