_____ ______ ______ is a renal lesion that causes a decline in creatinine clearance and is characterized by an inflammatory infiltrate in the kidney interstitium.
Acute Interstitial Nephritis (AIN)
Medications result in ____% of AIN.
What is the most common?
What additional medications can be responsible?
ABx (Penicillin, Cephalosporins, Bactrim, Ciprofloxacin)
NSAIDs PPIs (Omeprazole) Diuretics (Furosemide, Bumetamide) Rifampin ASA
What infections are associated with AIN?
What systemic diseases are associated with AIN?
What is the classic triad of AIN?
Onset is 3-5 days
In AIN, you would see a rise in serum _________ when the offending drug is administered?
Would you expect to see nephrotic ranges of proteinuria in AIN?
No it usually only elevated to about 1g/day
Fractional elevation of sodium excretion above 1% is indicative of _______ damage?
T/F: Radiographic studies are diagnostic for AIN
What would be seen on histology of AIN?
Is the glomerulus involved?
Diffuse interstitial infiltrate with many red-staining eosinophils
No glomerular involvement
How is AIN treated?
Remove causative agent
Glucocorticoids can be considered
What are examples of processes that result in chronic interstitial nephritis (CIN)?
Tubulointerstitial Nephritis and Uveitis
Arostolochic Acid containing herbs
In a a patient with analgesic nephropathy….
What may be seen on lab work?
Imaging of the kidneys?
Labs: Elevated Creatinine
UA: Hematuria, Sterile Pyuria, Mild Proteinuria
Imaging: Smaller kidneys, Clacifications
Chronic Interstitial Nephritis (CIN) as a result of ______ exposure usually presents with polyuria and polydipsia and a result of ________ channel degradation.
Is CIN due to lithium exposure a nephrotic or nephritic syndrome?
Nephrotic (Minimal Change Disease)
Other than polyuria and polydipsia, what additional clinical manifestations may be seen in CIN as a result of lithium exposure?
________ _______ ________ is a chronic tubulointerstitial disease associated with a high frequency of urothelial atypia, occasionally culminating in tumors of the renal pelvis and urethra.
This is common in Southeastern Europe
Balkan Endemic Nephropathy (BEN)
What is BEN most likely caused by?
Chronic exposure to low concentrations of aristolochic acid
How is BEN diagnosed?
Patient with slowly progressive chronic kidney disease who is living in or recently moved from an endemic area, particularly if the family history is positive for BEN
Inflammation in Tubulointerstitial Nephritis and Uveitis (TINU) is primarily __-lymphocyte driven
What Sxs may a patient with TINU present with?
What may be found on lab work/UA?
UA: Sterile Pyuria, Hematuria, Subnephrotic Proteinuria
T/F: TINU is typically self-limited and spontaneously resolves
________ is a cause of CIN as a result of interstitial infiltrates that invades and damages the tubules with granuloma formation
What antibodies are specific to Sjogrens?
What can be used to treat CIN as a reult of Sjogrens if severe enough?
What is commonly seen with renal involvement in sarcoidoisis?
On renal biopsy in a patient with sarcoidosis, would you expect to see caseating or non-caseating granulomas in the interstium?
Exposure to _____ _____ was first discovered in women presenting near ESRD after being at weight lose clinic.
This has been linked to a more rapid decline in renal function when compared to other forms of interstitial nephritis
Arostolochic Acid (AA)
Arostolochic Acid (AA) has been linked to interstitial fibrosis, atrophy, and loss of the ______
T/F: Arostolochic Acid (AA) is linked to a high incidence of uroepithelial CA
Lead exposure for extensive amounts of time (5-30 years) with blood levels _________ is linked to renal pathology
> 60 mcg/dL
In patients with renal disease linked to lead, a PMHx of ____ is often seen.
Renal phosphate wasting
Are all associated with a _______-type syndrome linked to lead exposure and renal disease
Is proteinuria common in patients with lead exposure and renal disease?
How can lead exposure and renal disease treated?
Minimize further lead exposure
When would chelation therapy be indicated for patients with lead poisoning and renal disease?
If exposure is acute, lead levels, and Sx