Acute Idiopathic Tubulointerstitial Nephritis: Report of Two Cases and Review of the Literature

Acute Interstitial Nephritis and Uveitis with Bone Marrow Granulomas and Anti-IMeutrophil Cytoplasmic Antibodies

“…The lack of specific immuno fluorescence findings and the presence of mononuclear cell infiltrates suggest instead that cellular immune-mediated inury is working in the disease. Indeed, most of the infiltrates in the kidney are T lymphocytes [9,16,20], However, data on peripheral lymphocyte function and populations have been inconsistent. The results previous ly reported are the temporary depression of cellular im munity with anergy [3,6], a slight decrease in T cells with a normal subpopulation ratio [16], a decrease in T cell population [14], a slight decrease in the OKT4/OKT8 ratio [20] and normal lymphocyte proliferation assay [8].…”

“…Some authors have reported good results with systemic steroid therapy [3,7,9,13,16,20], but its effectiveness has been debated because of spontaneous remission of AIN. However, Cacoub et al [18] reported that 2 of 4 adult patients who did not receive systemic steroid thera py developed chronic renal failure while none of 3 pa tients teated with steroids did.…”

Relapsing Steroid-Responsive Idiopathic Acute Interstitial Nephritis

“…The severity of renal failure has no clear correlation with the intensity of the interstitial infiltration, which is why in its pathogenesis, hemodynamic changes derived from tubulo glomerular adjustment are considered important [26,27]. Glycosuria, in the absence of hyperglyce mia, can be a key to IATN, and Fanconi syndrome, which is not infrequent, can be the reason for consultation [2,5,7,9,II,12], Characteristically, blood pressure is normal or slightly high and proteinuria scarce, although it may be higher than 2 g/day [9,10].…”

“…Treatment with corticosteroids is controversial although it appears that it may be beneficial by speeding up the recovery of renal function and avoiding the development of chronicity [1,3,4,6,7,[9][10][11][12][13][14]29]. Since there have been few cases, experience is very limited, and there are no controlled prospective studies or established guidelines.…”

“…Since there have been few cases, experience is very limited, and there are no controlled prospective studies or established guidelines. The use of steroids seems especially adequate when renal failure is severe and there is no marked fibrosis [9]. Since fibrosis may develop in a few weeks, it is important to treat it early [28].…”