Acute interstitial nephritis: aetiology and management

Schurder, Juliet; Buob, David; Perrin, Peggy; Thervet, Éric; Karras, Alexandre; Hertig, Alexandre

doi:10.1093/ndt/gfz262

Cited by 7 publications

(3 citation statements)

References 26 publications

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“…Since infections and antibiotics induce AIN through autoimmune and immuno-allergic pathomechanisms, respectively, it is possible that their histopathological and clinical characteristics may overlap. According to some studies, the leading cause of AIN is bacterial pyelonephritis, which can be unilateral and typically localized to the renal pyramid [ 67 ]. In this instance, a healthcare professional can utilize positive uroculture, or, in most instances, blood cultures as a diagnostic tool for infection-associated AKI, particularly when AKl occurs in the absence of septic shock [ 67 ].…”

Section: Features Of Infection In Correlation With Ainmentioning

confidence: 99%

“…According to some studies, the leading cause of AIN is bacterial pyelonephritis, which can be unilateral and typically localized to the renal pyramid [ 67 ]. In this instance, a healthcare professional can utilize positive uroculture, or, in most instances, blood cultures as a diagnostic tool for infection-associated AKI, particularly when AKl occurs in the absence of septic shock [ 67 ]. The presence of a large number of neutrophils [ 1 ], particularly as micro-abscesses, should alert one to the possibility of pyelonephritis [ 68 ].…”

Section: Features Of Infection In Correlation With Ainmentioning

confidence: 99%

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The diagnosis of acute interstitial nephritis caused by infection versus antibiotic-induced interstitial nephritis: a narrative review

Muhammad,

Zhang,

Huang

et al. 2024

Clinical Kidney Journal

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Acute interstitial nephritis (AIN) is a significant contributor to acute kidney injury (AKI) and can be attributed to a variety of factors, including but not limited to allergens or drugs, infections, autoimmune or systemic diseases, and idiopathic forms of the disease. In some cases, AIN requires a therapeutic action according to a single specific etiology by handling the offending agent and applying an immunosuppressant. Although AIN can be diagnosed through renal biopsy, it is not able to pinpoint the precise cause when multiple causes are suspected to be present simultaneously. Such situations arise when a patient suffering from infection develops AIN during its antibiotic therapy, which becomes a challenge for the clinicians to determine the exact causative factor. This is attributed to the different approaches employed in different etiologies, wherein clinicians are required to maintain the current antibiotic therapy or augment the dose in cases of infection as AIN etiology, without resorting to immunosuppressant therapy as the primary objective is infection killing. In contrast, antibiotics as an etiology for AIN require an alternative drug from the antibiotics group, along with an immunosuppressant. In the interim, delaying the identification of the precise cause may result in interstitial fibrosis and chronic kidney disease (CKD). This narrative review highlights certain findings that can be typical of infection-associated ATIN compared to antibiotic-associated ATIN based on clinical history and physical examination, clinical presentation of different antibiotic drug classes, histopathological features, classical and novel biomarkers, serum and urine cytokines and chemokines, cellular biomarkers, and genetic biomarkers. Although these findings cannot provide conclusive and clear recommendations that can be useful in the clinical practice, but they can entice researchers to conduct original research on these features to discover clear recommendations.

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Section: Features Of Infection In Correlation With Ainmentioning

confidence: 99%

Section: Features Of Infection In Correlation With Ainmentioning

confidence: 99%

The diagnosis of acute interstitial nephritis caused by infection versus antibiotic-induced interstitial nephritis: a narrative review

Muhammad,

Zhang,

Huang

et al. 2024

Clinical Kidney Journal

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“…The incidence of kidney pathologies, nephrosis and nephritis in particular, is constantly growing all over the world in recent years [1][2][3]. The number of patients with acute IAI associated with nephritis is constantly growing [4] respectively.…”

Section: Introductionmentioning

confidence: 99%

Untitled

2023

JUNS

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Introduction: Actuality is due to rather understudied state of fibrinolytic reactions in case of NN with acute IAI which is to be found in practice more frequent. Objective of the study was studying of the features of fibrinolytic activity in case of IAI, that is being developed underlying NN.Materials and Methods: 100 albino non-pedigree rats. IAI was simulated through the intra-abdominal puncture injection of a 20% auto fecal mixture. NN was simulated by subcutaneous introduction of 5% sodium nitrite solution on distilled water. In the course of the study total TFA, NFA and EFA of blood plasma were studied. The animals were divided into such groups: 1 -intact animals with IAI models, 2 -animals with models of IAI underlying NN. Results:The activity of fibrinolysis in animals with NN models predominated over the one in intact animals. In 6 hours since IAI was modeled, FA started increasing in both animal groups. However, all of TFA, EFA and NFA in group 1 were increasing statistically significantly. Whereas group 2 was affected by a minor increase. In 12 hours in group 1 FA of plasma was increasing statistically significantly. In group 2 FA of plasma was increasing insignificantly. There was a meaningful increase of EFA in group 1, in contrast, it was insignificant in group 2. The ratio between EFA and NFA decreased in group 1. In contrast, this ratio in group 2 increased statistically significantly and the parameters of EFA indicator in group 2 were statistically significantly higher. In 24 hours, parameters of TFA, NFA and EFA indica-tors in both groups have not changed much. At the same time, the ratio between EFA and NFA was increasing statistically significantly in group 1. In group 2 the ratio decreased. In 48 hours, FA plasma and the ratio of different fibrinolysis elements did not change much in group 1. The parameters of TFA and EFA in group 2 were increasing statistically significantly. The parameters of NFA were decreasing statistically significantly. The ratio between EFA and NFA in group 2 was decreasing very significantly. Conclusiona) The increase in the fibrinolytic activity of blood plasma with the non-enzymatic mechanism's predomination have been found in experimental nephrosis-nephritis case.b) The activation of fibrinolysis with balance maintenance between its links within 24 hours has been observed in experimental acute intra-abdominal infection case. c) In 6 hours, the development of acute intra-abdominal infection in animals with simulated nephrosis-nephritis differs substantially in its quantitative characteristics of the fibrinolytic activity of plasma blood, which is shown by its lack of proper increase, development of imbalance be-tween the links of fibrinolysis, uncontrolled increase of the activity of fermentation mechanisms with disseminated intravascular coagulation syndrome in 48 hours.d) The basis of the differences that have been detected are the changes in the functional activity of the fibrinolytic system caused by nephrosis-nephritis influence that, in addition to changes in ...

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