Clinical profile and outcome of patients with biopsy-proven acute interstitial nephritis in Cape Town: a 10-year review

Abstract

AIN is common in patients with HIV or those on treatment for tuberculosis. Drug-related AIN is often associated with improved outcomes. This is particularly reassuring in the SSA region where the use of potentially-inciting medications is rife from a high burden of HIV and tuberculosis. .

Kidney disease in Africans with HIV and tuberculosis

“…Substantial reversibility of kidney failure was observed in the Cape Town cohort, even among those who required dialysis. This findings is consistent with a previous study of acute interstitial nephritis from Cape Town [27]. Specialist nephrology services are extremely sparse in sub-Saharan Africa and RRT is rarely available.…”

“…Additionally, this prevalence estimate may be under-estimated as (non-granulomatous) interstitial nephritis was not considered diagnostic of renal TB. Although interstitial nephritis may be indicative of rifampicin or co-trimoxazole-induced renal toxicity [27], interstitial nephritis in the Abidjan cohort was more common in those with a post-mortem TB diagnosis (many also had HIV diagnosed post-mortem), suggesting this may also reflect a localised or systemic inflammatory immune response to TB in the kidney, in the setting of uncontrolled HIV replication. Finally, there may be a degree of overlap in clinical and pathological features of ATN from TDF toxicity and other causes such as sepsis; we may therefore have underestimated the contribution of TDF to the burden of kidney disease in the Cape Town cohort.…”

Acute interstitial nephritis and nephrogenic diabetes insipidus following treatment with sulfamethoxazole‐trimethoprim and temozolomide

“…5,6 AKI is not uncommonly reported following treatment with sulfamethoxazole-trimethoprim 7 and there are at least 35 published cases of AIN attributable to treatment with sulfamethoxazole-trimethoprim. [8][9][10] The incidence of AIN related to sulfamethoxazole-trimethoprim in kidney transplant recipients is reported to be as high as 2%. 11 Similar to other drugs, sulfamethoxazole-trimethoprim-induced AIN usually presents within 7 to 10 days after exposure, but can be delayed by weeks or months.…”

“…AKI is not uncommonly reported following treatment with sulfamethoxazole‐trimethoprim 7 and there are at least 35 published cases of AIN attributable to treatment with sulfamethoxazole‐trimethoprim 8‐10 . The incidence of AIN related to sulfamethoxazole‐trimethoprim in kidney transplant recipients is reported to be as high as 2% 11 .…”

Nefritis tubulointersticial aguda. Revisión bibliográfica

“…Entre los microorganismos relacionados con la presencia de la NTIA se destacan: la Legionella, Leptospira, cytomegalovirus (CMV), Streptococcus, Mycobacterium tuberculosis, Corynebacterium diphtheriae, virus de Epstein-Barr (EBV), Yersinia, Polyomavirus, Enterococcus, Escherichia coli, adenovirus, virus BK y Candida. Los pacientes infectados por VIH son particularmente susceptibles al desarrollo de las enfermedades de hipersensibilidad renal, no solo por el compromiso infeccioso derivado directamente por el genoma viral, sino por las coinfecciones y el uso constante de diferentes medicamentos (antiretrovirales, antimicrobianos y medicamentos antituberculosos) (3,12,32,33) . En un estudio en donde se revisaron 262 biopsias renales de pacientes con VIH, se encontró que cerca del 11 % de ellos presentaron la NTIA sin compromiso de la función renal; de estos, en el 72 % la causa de la NTIA fue asociada con medicamentos, especialmente, AINES y trimetoprim sulfametoxazol (32) .…”