Jade acute tubulointerstitial - Causes, symptoms and treatment. MF.

This disease is not as rare as one can think of it. And the diagnosis is not always put accurately and not always on time. This information will be useful to doctors so that if the patient's kidney function worsens suddenly, the patient should include in the list of possible causes and this pathology, and patients who will turn to the doctor on time and will not forget to mention what still could provoke the disease.

Acute interstitial nephritis( acute tubulointerstitial nephritis) is a diffuse lesion of the kidneys, manifested by an acute decrease in their function due to inflammation and edema of renal interstitium( cell and aqueous exudation in interstitial tissue).

Thus, not the glomeruli "from the inside" are affected, but the tissue that surrounds them and should, in theory, protect it. However, this tissue( interstitium) swells, interferes with the work of the glomeruli and tubules, as a result of which the kidney function deteriorates sharply.

Causes of acute tubulointerstitial nephritis

What causes the disease, what is the reason? Acute tubulointerstitial nephritis occurs under the influence of some provoking factor( drugs, infections).The exact mechanism of development of interstitial nephritis is unknown, there is evidence in favor of its immune genesis, in some way it can be considered as a hypersensitivity reaction( for example, to certain drugs) in individuals.

The most common cause of development of tubulointerstitial nephritis is the intake of certain medications. The spectrum of such drugs is very wide, for example, medicinal acute tubulointerstitial nephritis can cause such drugs as: antibiotics, nonsteroidal anti-inflammatory drugs, diuretics, antihistamines, allopurinol, aspirin, azathioprine, captopril, diazepam, Chinese herbs used for weight loss. Most often, of course, acute interstitial nephritis is caused by a variety of non-steroidal anti-inflammatory drugs( so-called "dental, headache and back pain" tablets).

The development of the disease does not depend on the dose of the drug, and it is impossible to predict the possibility of a person's reaction to a drug in the form of acute interstitial nephritis only if the patient already had similar episodes in the anamnesis. In the presence of risk factors( liver disease, kidney disease, hyponatremia and hypovolemia, previous treatment with diuretics, heart failure, immunological diseases, post-operative condition, advanced age), the incidence of acute interstitial nephritis increases.

The bacterial and viral infections( diphtheria, brucella, legionella, campylobacter, toxoplasma, mycoplasma, rickettsia, syphilis, leptospirosis, cytomegalovirus) can also cause tubulointerstitial nephritis.

If the cause of the disease is not diagnosed, they talk about idiopathic tubulointerstitial nephritis.

Symptoms of acute tubulointerstitial nephritis

The main symptoms:

The onset is acute, manifested 1-30 days after the onset of the etiological factor( cause).Thirst arises, often polyuria( a large amount of urine), rash( petechial or maculopapular), fever, sometimes pain in the lumbar region. Less often there may be swelling and a decrease in the amount of urine until it is absent( anuria).Edema and a large amount of protein in the urine is more typical of acute tubulointerstitial nephritis, caused by the use of non-steroidal anti-inflammatory drugs. At a nephrite of other etiology edemas are more often absent.

It is very difficult to diagnose yourself by yourself, it is necessary to turn to a specialist( therapist, nephrologist) and pass a number of tests, undergo a survey. Be sure to mention all the factors that could provoke the disease in a conversation with a doctor: taking medications, suffering infections, consuming various herbs and teas for weight loss and for other purposes.

What is necessary to establish the correct diagnosis?

For the diagnosis of acute tubulointerstitial nephritis it is necessary to make a number of analyzes:

• Clinical blood test - as a rule, the disease is accompanied by eosinophilia, anemia. There may also be signs of inflammation such as leukocytosis and an increase in ESR.
• Biochemical blood test - indicates damage to kidney tissue and determines the severity of the lesion. Signs: increased levels of urea and creatinine, often - increased blood transaminases, changes in electrolyte blood, metabolic acidosis.
• General urine analysis - low urine density, proteinuria, hematuria, cylinduria.
• US of kidneys - kidneys of usual or increased sizes.
• If necessary, perform nephrobiopsy. Morphologically: interstitial inflammation with eosinophils, lymphocytic infiltration of tubules, necrosis of tubular epithelium.

Treatment of acute tubulointerstitial nephritis

Obligatory hospitalization of the patient in the hospital.

First, it is necessary to cancel the drug that caused the disease( analgesics, antibiotics, etc.), or stop contact with toxins. It is important to use liquid in sufficient quantities. Correction of disorders caused by renal dysfunction is carried out: correction of acidosis( intravenous solution of soda in hospital), correction of anemia( iron preparations, erythropoietin), normalization of blood pressure( oral anti-hypertensive drugs), correction of water-electrolyte disorders( hypokalemia, hyperkalemia).Treatment of acute renal failure itself: diuretics intravenously( lasix);drugs that improve kidney blood flow( pentoxifylline, trental, euphyllin), antihistamines( suprastin, tavegil).

In the absence of the effect of treatment for 7 days, or with increasing renal failure, the option of initiating glucocorticosteroid therapy is considered - prednisolone 30-40 mg / day to 60 mg / day for 2-3 weeks, in severe cases - pulse-therapy 1000 mgin / in 3 days, with a decrease in dosage and further cancellation.

Treatment with folk remedies and herbs is fraught with even greater exacerbation of renal dysfunction, since it is unknown how inflamed interstitial renal tissue will react to concentrated bioflavonoids of various decoctions.

As a rule, on the background of treatment renal failure is resolved within a month.

If the treatment is not effective and the kidney failure increases: oliguria continues, the symptoms of uremia grow 5-7 days, increase the potassium level over 6.5 mmol / l, metabolic acidosis, which is not amenable to correction, the creatinine level exceeds 0.7 mmol / l, hyperhydrationwith clinical and radiologic manifestations of pulmonary edema - the patient is transferred to the intensive care unit and hemodialysis sessions are conducted. In the future, treatment is carried out as usual.

In treatment recommended bed rest, sparing diet with restriction of table salt.

Possible complications of acute tubulointerstitial nephritis

Without timely adequate treatment, pulmonary edema is possible;the transition of the disease into a chronic form is possible. With qualified treatment, a good response of the patient to therapy and the abolition of provocative drugs, the kidney function is restored to its full extent.

After discharge, the patient needs regular follow-up for 5 years:

Inspect the nephrologist 2 times a year( at the polyclinic or city nephrological center).Control of blood tests( clinical, biochemical), urine. Med.vodov from vaccinations for 1-2 years. Sanitation of chronic foci of infection( treatment of caries, tonsillectomy, treatment of chronic pyelonephritis and adnexitis, etc.)

The patient's recovery after recovery is fully restored. In the case of development of chronic renal failure, the frequency of examinations of the patient increases to 4-6 times a year.

Prevention of acute tubulointerstitial nephritis

It is difficult to predict how and what the human body will respond to at the moment. Against the backdrop of an unfavorable environmental situation and the massive introduction of all kinds of drugs, their accessibility and active advertising - all this leads to sometimes uncontrolled reception of medications that a person appoints himself.

Knowing all this, you must be careful with your body and follow a number of rules:

1) Avoid unknown drugs that have not been certified in the Russian market, for example, all kinds of biological supplements, Chinese herbs and teas for weight loss, "magic capsules" curing everything.
2) Do not abuse drugs, even the most "harmless."It is not necessary at any pain to take a powerful non-steroidal anti-inflammatory drug, especially daily. If something is very disturbing, it is better to solve this problem together with the attending physician.
3) Do not take yourself diuretics, thinking that in this way get rid of edema and look slimmer. These drugs - only in consultation with the doctor.
4) If there is any reaction to the drug in the form of rash, swelling, fever, you should immediately consult a doctor.
5) Maintain a healthy lifestyle, adhere to proper nutrition, do not abuse tablets, but if the drug is prescribed by a doctor according to the indications, take it as recommended to preserve your health.

Article written by the doctor nephrologist