Highlights & Basics
- Acute interstitial nephritis (AIN) is caused by acute inflammation of the renal tubulo-interstitium, commonly mediated by a hypersensitivity reaction to medications. Autoimmune diseases and infections are less common causes.
- Usually drug-induced with >250 known triggering medications. Common classes include beta-lactam and fluoroquinolone antibiotics, proton-pump inhibitors, nonsteroidal anti-inflammatory drugs (NSAIDs), and immune checkpoint inhibitors. Also occurs in inflammatory diseases such as sarcoidosis, Sjogren syndrome, IgG4-related diseases, and tubulointerstitial nephritis with uveitis (TINU) syndrome. Various infectious agents (viruses, bacteria, fungi) and some malignancies can also cause AIN.
- Presents with acute kidney injury or subacute loss of kidney function. The "hypersensitivity triad" of rash, fever, and eosinophilia occurs rarely (<10%). Nephrotic syndrome may be present in cases triggered by NSAIDs.
- Clinical diagnosis relies on maintaining a high index of clinical suspicion for this disease and performing a kidney biopsy to obtain tissue for histologic diagnosis. Histologic features of interstitial immune infiltrate, eosinophils, and tubulitis are considered characteristic of this disease.
- May resolve once the triggering medication is discontinued. Corticosteroid therapy may be associated with greater recovery of kidney function.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Citations
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Moledina DG, Perazella MA. Drug-induced acute interstitial nephritis. Clin J Am Soc Nephrol. 2017 Dec 7;12(12):2046-9.[Abstract][Full Text]
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