Pediatric Cases Diagnosed with Drug-Related Acute Tubulointerstitial Nephritis: A Single-Center Experience
Abstract
Aim: Acute tubulointerstitial nephritis (TIN) is inflammation of the renal interstitium. It is also a common cause of acute kidney injury (AKI). The aim is to contribute to the literature by evaluating patients diagnosed with drug-induced TIN.
Material methods: 29 Turkish children aged between 3 and 217 months, 5 of whom had undergone a biopsy, were retrospectively analyzed in terms of clinical and laboratory findings.
Results: 29 patients, 19 of whom were girls, were evaluated. The mean age at diagnosis was 138.6(3-217) ± 67.4 months. Nausea-vomiting complaint of 12 cases, 6 under treatment during hospitalization, 4 with headache, 2 with isolated fatigue, and the remaining 5 patients with incidentally detected renal function test disorder, oligo-anuria, urinary incontinence, red urination, and uveitis. At the time of diagnosis, 4 patients had hypertension and 26 patients had AKI. Two of these cases were anuric. The low eGFR values at the time of diagnosis were observed to improve at the end of the follow-up. Hematuria was detected in 18 cases and of them were macroscopic hematuria. 4 patients had pyuria, 19 patients had proteinuria, and 2 of them were nephrotic. FeNa was the most common abnormality of the tubular tests with 4.5%. Biopsy was performed in 5 cases. While one of the patients presented with uveitis, uveitis developed in 1 patient during the 3rd month of follow-up.
Conclusion: Consequently, although TIN is a reversible disease, its recognition is important in terms of treatment and follow-up.
References
- Ulinski T, Sellier-Leclerc AL, Tudorache E, Bensman A, Aoun B. Acute tubulointerstitial nephritis. Pediatr Nephrol. 2012; 27:1051–1057
- Eddy AA. Drug-induced tubulointerstitial nephritis: hypersensitivity and necroinflammatory pathways. Pediatr Nephrol. 2020; 35:547–554
- Muriithi AK, Leung N, Valeri AM, et al. Biopsy-proven acute interstitial nephritis, 1993-2011: a case series. Am J Kidney Dis. 2014; 64:558.
- Muriithi AK, Leung N, Valeri AM, et al. Clinical characteristics, causes and outcomes of acute interstitial nephritis in the elderly. Kidney Int. 2015; 87:458
- Praga M, Sevillano A, Auñón P, González E. Changes in the etiology, clinical presentation, and management of acute interstitial nephritis, an increasingly common cause of acute kidney injury. Nephrol Dial Transplant. 2015;30:1472
- Perazella AM, Rosner HM. Drug-induced acute kidney injury. Clin J Am Soc Nephrol. 2022; 17:1220-1233.
- Praga M, González E. Acute interstitial nephritis. Kidney Int. 2010; 77:956
- Fernandez-Juares G, Perez VJ, Caravaca-Fontan F, et al. Duration of treatment with corticosteroids and recovery of kidney function in acute interstitial nephritis. Clin J Am Soc Nephrol. 2018; 13:1851-1858.
- Chowdry AM, Azad H, Mir I, et al. Drug-induced acute interstitial nephritis: prospective randomized trial comparing oral steroids and high dose intravenous pulse steroid therapy in guiding the treatment of this condition. Saudi J Kidney Dis Transpl. 2018; 29:598-607.
- Muriithi AK, Nasr SH, Leung N. Utility of urine eosinophils in the diagnosis of acute interstitial nephritis. Clin J Am Soc Nephrol. 2013; 8:1857
- Joyce E, Glasner P, Ranganathan S, Swiatecka-Urban A. Tubulointerstitial nephritis: diagnosis, treatment, and monitoring. Pediatr Nephrol. 2017; 32(4):577-587.
- Latcha S, Jaimes EA, Patil S, Glezerman IG, Mehta S, Flombaum CD. Long-term renal outcomes after cisplatin treatment. Clin J Am Soc Nephrol. 2016; 11: 1173-1179.
- Saha H, Mustonen J, Helin H, Pasternack A. Limited value of the fractional excretion of sodium test in the diagnosis of acute renal failure. Nephi Dia Trans. 1987; 2:79
- Raissian Y, Nasr SH, Larsen CP, et al. Diagnosis of IgG4-related tubulointerstitial nephritis. J Am Soc Nephrol. 2011; 22:1343
- Kobayashi Y, Honda M, Yoshikawa N, Ito H. Acute tubulointerstitial nephritis in 21 Japanese children. Clin Nephrol. 2000; 54(3):191-197.
- Jahnukainen T, Saarela V, Arikoski P, et al. Prednisone in the treatment of tubulointerstitial nephritis in children. Pediatr Nephrol. 2013; 28:1253–1260
- Prendecki M, Tanna A, Salama AD, et al. Long-term outcomes in biopsy-proven acute interstitial nephritis treated with steroids. Clin Kidney J. 2017; 10:233-239.
- Wente-Schulz S, Aksenova M, Awan A, et al. Aetiology, course and treatment of acute tubulointerstitial nephritis in paediatric patients: a cross sectional web-based survey. BMJ Open. 2021; 11(5): e047059.
- Clive MD, Vanguri VK. The Syndrome of Tubulointerstitial Nephritis With Uveitis (TINU). Am J Kidney Dis. 2018; 72(1):118-128.
- Chevalier A, Duflos C, Clave S, et al. Renal prognosis in children with tubulointerstitial nephritis and uveitis syndrome. Kidney Int Rep. 2021; 7(12):3045-3053.
- Pereira C, Costa-Reis P, Esteves da Silva J, Stone R. A child with tubulointerstitial nephritis and uveitis (TINU) syndrome. BMJ Case Rep. 2018:17; bcr2017222766.
Çocuk Hastalarda İlaç İlişkili Akut Tübülointerstisyel Nefritin Değerlendirilmesi: Tek Merkez Deneyimi
Abstract
Amaç: Akut tubulointerstisyel nefrit (TIN), renal interstisyumun inflamasyonudur. Aynı zamanda akut böbrek hasarının (ABH) yaygın bir nedenidir. Amaç ilaca bağlı TIN tanısı alan hastaları değerlendirerek literatüre katkıda bulunmaktır.
Gereç ve Yöntem: Yaşları 3-217 ay olan 29 Türk çocuğu klinik ve laboratuvar bulguları açısından retrospektif olarak incelendi. 5 hastaya biyopsi yapıldığı görüldü.
Bulgular: 19'u kız olmak üzere 29 hasta değerlendirildi. Ortalama tanı yaşı 138,6(3-217) ± 67,4 ay idi. Başvuru şikayetleri değerlendirildiğinde 12 hastada bulantı-kusma, 4 hastada başağrısı ve 2 hastada izole halsizlik olduğu görüldü. 5 hastanın başka sebeplerle hastaneye başvurusu sonucu insidental olarak, 6 ise hastanın farklı nedenlerle hospitalizasyonu sırasında izlemde tanı aldığı belirlendi. 26 hastada ABH bulunmaktaydı ve 4 hasta hipertansifti. İki hasta anürikti. Tanı anında düşük olan eGFR değerlerinin takip sonunda düzeldiği görüldü. 18 olguda hematüri saptandı ve makroskopikti. 4 hastada piyüri, 19 hastada proteinüri vardı ve 2 hastada nefrotik düzeydeydi. FeNa %4,5 ile tübüler testlerde en sık görülen anormallikti. 5 olguya biyopsi yapıldı. Hastalardan biri üveit şikayeti ile başvururken, 1 hastanın takibinin 3. ayında üveit gelişti.
Sonuç: Sonuç olarak TIN geri dönüşümlü bir hastalık olmasına rağmen tanınması tedavi ve takip açısından önemlidir.
Keywords
References
- Ulinski T, Sellier-Leclerc AL, Tudorache E, Bensman A, Aoun B. Acute tubulointerstitial nephritis. Pediatr Nephrol. 2012; 27:1051–1057
- Eddy AA. Drug-induced tubulointerstitial nephritis: hypersensitivity and necroinflammatory pathways. Pediatr Nephrol. 2020; 35:547–554
- Muriithi AK, Leung N, Valeri AM, et al. Biopsy-proven acute interstitial nephritis, 1993-2011: a case series. Am J Kidney Dis. 2014; 64:558.
- Muriithi AK, Leung N, Valeri AM, et al. Clinical characteristics, causes and outcomes of acute interstitial nephritis in the elderly. Kidney Int. 2015; 87:458
- Praga M, Sevillano A, Auñón P, González E. Changes in the etiology, clinical presentation, and management of acute interstitial nephritis, an increasingly common cause of acute kidney injury. Nephrol Dial Transplant. 2015;30:1472
- Perazella AM, Rosner HM. Drug-induced acute kidney injury. Clin J Am Soc Nephrol. 2022; 17:1220-1233.
- Praga M, González E. Acute interstitial nephritis. Kidney Int. 2010; 77:956
- Fernandez-Juares G, Perez VJ, Caravaca-Fontan F, et al. Duration of treatment with corticosteroids and recovery of kidney function in acute interstitial nephritis. Clin J Am Soc Nephrol. 2018; 13:1851-1858.
- Chowdry AM, Azad H, Mir I, et al. Drug-induced acute interstitial nephritis: prospective randomized trial comparing oral steroids and high dose intravenous pulse steroid therapy in guiding the treatment of this condition. Saudi J Kidney Dis Transpl. 2018; 29:598-607.
- Muriithi AK, Nasr SH, Leung N. Utility of urine eosinophils in the diagnosis of acute interstitial nephritis. Clin J Am Soc Nephrol. 2013; 8:1857
- Joyce E, Glasner P, Ranganathan S, Swiatecka-Urban A. Tubulointerstitial nephritis: diagnosis, treatment, and monitoring. Pediatr Nephrol. 2017; 32(4):577-587.
- Latcha S, Jaimes EA, Patil S, Glezerman IG, Mehta S, Flombaum CD. Long-term renal outcomes after cisplatin treatment. Clin J Am Soc Nephrol. 2016; 11: 1173-1179.
- Saha H, Mustonen J, Helin H, Pasternack A. Limited value of the fractional excretion of sodium test in the diagnosis of acute renal failure. Nephi Dia Trans. 1987; 2:79
- Raissian Y, Nasr SH, Larsen CP, et al. Diagnosis of IgG4-related tubulointerstitial nephritis. J Am Soc Nephrol. 2011; 22:1343
- Kobayashi Y, Honda M, Yoshikawa N, Ito H. Acute tubulointerstitial nephritis in 21 Japanese children. Clin Nephrol. 2000; 54(3):191-197.
- Jahnukainen T, Saarela V, Arikoski P, et al. Prednisone in the treatment of tubulointerstitial nephritis in children. Pediatr Nephrol. 2013; 28:1253–1260
- Prendecki M, Tanna A, Salama AD, et al. Long-term outcomes in biopsy-proven acute interstitial nephritis treated with steroids. Clin Kidney J. 2017; 10:233-239.
- Wente-Schulz S, Aksenova M, Awan A, et al. Aetiology, course and treatment of acute tubulointerstitial nephritis in paediatric patients: a cross sectional web-based survey. BMJ Open. 2021; 11(5): e047059.
- Clive MD, Vanguri VK. The Syndrome of Tubulointerstitial Nephritis With Uveitis (TINU). Am J Kidney Dis. 2018; 72(1):118-128.
- Chevalier A, Duflos C, Clave S, et al. Renal prognosis in children with tubulointerstitial nephritis and uveitis syndrome. Kidney Int Rep. 2021; 7(12):3045-3053.
- Pereira C, Costa-Reis P, Esteves da Silva J, Stone R. A child with tubulointerstitial nephritis and uveitis (TINU) syndrome. BMJ Case Rep. 2018:17; bcr2017222766.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | March 19, 2024 |
| Submission Date | May 23, 2023 |
| Published in Issue | Year 2024 |