Intersticial nephrite
Intersticial nephrite (tubulointerstitsialny nephrite or tubulointerstitsialny nephropathy) – the pathological process characterized by chronic or acute inflammatory defeats of tubules of kidneys and intersticial fabric. Use of drugs for infections, obstruction of urinary tract, metabolism disturbances, toxic influences and malignant new growths can be origins of intersticial nephrite.
At acute intersticial nephrite there are inflammatory changes of tissues of kidneys that as a result can lead to development of a renal failure.
At chronic intersticial nephrite there is a development of fibrosis of intersticial fabric, defeat of balls (at a late stage of a disease) and an atrophy of tubules. In the started state chronic intersticial nephrite leads to a nephrosclerosis (wrinkling of kidneys).
Reasons of intersticial nephrite
Intersticial nephrite can arise because of reception of the following medicines:
- Beta лактамных antibiotics;
- Ftorkhinolonov;
- Sulfanilamidov;
- Non-steroidal anti-inflammatory drugs;
- Diuretikov.
Can lead reception of such drugs to development of acute intersticial nephrite as:
- Allopyrinolum;
- Ampicillin;
- Gentamycin;
- Ibuprofen;
- Immunodepressants;
- Captopril;
- Kloksatsillin;
- Naproxenum;
- Penicillin;
- Rifampicin;
- Thiazide diuretics;
- Phenytoinum;
- Fenapdion;
- Cefalotin.
Also bacterial (diphtheria, streptococcal infections, legionellosis and leptospirosis) and virus (Epstein-Burra's virus, a cytomegalovirus and an arbovirus) infections, immune diseases (Shegren's syndrome, a system lupus erythematosus, a syndrome of rejection of a transplantirovanny kidney and a cryoglobulinemia), limfoproliferativny diseases and a multiple myeloma are the reasons of intersticial nephrite.
Obstruction of urinary tract, granulematozny diseases, disturbance of metabolism of cystine, urates, calcium and oxalates, vesicoureteral reflux and long influence of heavy metals lead to chronic intersticial nephrite.
Sometimes there is impossible an establishment of the reason of intersticial nephrite - in such cases the use of the term "idiopathic intersticial nephrite" takes place.
Symptoms of intersticial nephrite
Clinical displays of intersticial nephrite are the eosinophilia, fever and skin rash. Fever is a symptom of the intersticial nephrite observed practically at all patients. Skin rash is a symptom of the intersticial nephrite which is found approximately at a half of patients. Places of its emergence are the trunk and proximal departments of extremities, often skin rash is followed by an itch.
Also symptoms of intersticial nephrite are:
- Arthralgia;
- Back pain;
- Gross hematuria;
- Moderate proteinuria;
- Leukocyturia;
- Microhematuria;
- Proteinuria;
- Increase in kidneys;
- The increased maintenance of IgE in blood;
- Polyuria;
- Oliguria.
Treatment of intersticial nephrite
Treatment of intersticial nephrite (acute) consists in cancellation of drugs which can be the reasons of its emergence. At reception of a course of antibiotics, non-steroidal anti-inflammatory drugs and other medicines the repeated research of content of urea and creatinine in blood serum, definition of a daily urine, frequent checks and analyses of urine is necessary, and also at an opportunity it is necessary to replace nefrotoksichny agents with non-toxic.
Important elements of treatment of intersticial nephrite are: ensuring adequate hydration of the patient, reduction of doses and frequency rates of administration of other drugs, cancellation of the kidneys of medicines and inhibitors of an angiotensin-converting enzyme breaking functions. If intersticial nephrite leads to increase of a renal failure, then Prednisolonum reception is necessary (60 mg a day for 10-14 days).
At heavy renal failures use pulse therapy Methylprednisolonum is possible (1 g intravenously daily for three days).
At treatment of the intersticial nephrite accompanied with an oligoanuriya and bystry increase of level of creatinine purpose of a hemodialysis is necessary.
The patient with intersticial nephrite has to be informed that use of medicine which caused development of a disease, unacceptably in the future as repeated introduction of this medicine can lead to development of a catastrophic renal failure.
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