The article presents a clinical case of toxininduced acute kidney injury. The authors analyzed the cause of the event, revealed the pathogenesis of toxin injury of the kidneys, and described the main principles of treatment. The authors used this clinical case to show the importance of timely renal replacement therapy and the influence of comorbid pathology on disease development. The onset of acute kidney injury in patients with surrogate alcohol intoxication manifested as combined kidney and liver injury was described. The article may be of interest to doctors of all specialties, especially for therapists and surgeons who are the first to reveal acute kidney injury and their choice of adequate management ultimately determines the outcome.
Acute tubulointerstitial nephritis (ATIN) is an acute kidney disease that can develop under the influence of various exogenous and endogenous factors and is manifested by inflammatory changes in the tubulointerstitial tissue of the kidneys, often accompanied by the development of acute renal kidney damage (AKI). Approximately 3–19% of all AKI cases are due to ATIN nephrobiopsy data, which indicates a difficult non-invasive diagnosis of this disease. Complaints of patients with ATIN are few and are associated with manifestations of acute renal damage: a decrease in urine volume, an increase in blood pressure (BP). Important in the diagnosis of ATIN is urinary syndrome, manifested by proteinuria less than 1 gram per day, erythrocyturia, leukocyturia, including eosinophiluria. In patients with suspected ATIN, a full physical examination is performed, attention is drawn to the appearance of pain on palpation of the kidneys, blood pressure is measured, diuresis, and the presence of edema are assessed. In laboratory diagnostics, it is necessary to investigate the level of creatinine, blood urea, general urine analysis, with instrumental — ultrasound examination of the kidneys, if indicated, a kidney biopsy is performed. Treatment is aimed at immediate cessation of the effect of the etiological factor, maintenance of waterelectrolyte balance and correction of violations of acidbase balance, blood pressure. In this regard, it is possible to use crystalloid solutions, loop diuretics (furosemide, torasemide), antihypertensive drugs in accordance with the general principles of management of patients with AKI, immunosuppressive therapy for ATIN immune genesis, with ATIN drug genesis — glucocorticoids. In the presence of appropriate indications, renal replacement therapy is performed. The prognosis of the disease often depends on timely diagnosis and appropriate treatment. The paper presents the clinical case of a female patient affected with acute tubulointerstitial nephritis.
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