Acute drug-induced tubulointerstitial nephritis

Currently, medications have the leading position in the development of acute tubulointerstitial nephritis. Antibiotics, proton pump inhibitors and non-steroidal anti-inflammatory drugs are the most common etiologic agents of acute tubulointerstitial nephritis. Various drugs produce ambiguous types of immune response. For instance, antibiotics may induce a systemic allergic reaction, including fever, skin rash, eosinophilia and arthralgia, whereas non-steroidal anti-inflammatory drugs and proton pump inhibitors may evoke a subclinical cell-modified response. Blood and urine tests, as well as renal ultrasound examination do not allow establishing a highly reliable diagnosis of acute tubulointerstitial nephritis. Therefore, renal biopsy is essential for the diagnosis. Morphological abnormalities include interstitial inflammation and tubulitis. In a patient who is on any medication and is having high serum creatinine levels, decreased glomerular filtration rate, and urine test abnormalities, the possibility of acute tubulointerstitial nephritis should be considered by the clinician; the disease can manifest at various time intervals after intake of the drug (from several days to months). Treatment approach is based first of all on immediate withdrawal of the nephrotoxic agent and possible administration of immunosuppressive therapy. Timely diagnosis and early administration of glucocorticoids in morphologically confirmed tubulointerstitial nephritis are critical for restoration of the kidney functioning. Chronic kidney disease can develop in some patients. Clinicians in any specialty have to know about potential negative consequences of the use of antibiotics, non-steroidal anti-inflammatory drugs, proton pump inhibitors and other medications and to consider nephrotoxic factors.