Interstitielle Nephritis bei rheumatischen Erkrankungen

Abstract

Interstitial nephritis is responsible for about 12 % of end-stage renal disease in Germany. It comprises an etiologically heterogenous group of inflammatory renal disorders which primarily affect the renal interstitium and tubuli. Drugs, predominantly antibiotics, nonsteroidal anti-inflammatory drugs and proton pump inhibitors are causative in the majority of cases. Rheumatic diseases frequently affect the kidneys, either the glomeruli or the interstitial tissues. Inflammatory interstitial processes can be accompanied by complex functional tubular disorders. This review gives an overview about clinical and laboratory findings of interstitial nephritis in the context of rheumatic diseases. Sarcoidosis, tubulointerstitial nephritis and uveitis (TINU) syndrome, primary Sjogren's syndrome, and IgG4-related disease often show an interstitial nephritis when the kidneys are affected. Other diseases, such as systemic lupus erythematosus, systemic sclerosis, drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, and granulomatosis with polyangiitis are more rarely associated with predominant interstitial nephritis. Glucocorticoids are the mainstay of therapy for most cases; in refractory cases or when side effects occur, second-line immunosuppressants such as mycophenolate mofetil, azathioprine and others, rarely biologics, can be used.

Azathioprine-Induced Tubulo-Interstitial Nephritis in Graft Kidney Transplant

“…In acute allergic drug-induced interstitial nephritis, the major histologic abnormalities are in the interstitium which is expanded by a number of inflammatory cells with the presence of large numbers of eosinophils, as is seen in this patient [7,10,15,18,19]. The true incidence of AZA causing TIN is not very well known.…”

“…Prognosis is favourable with drug cessation, and re-challenge should be avoided because of the risk of a severe, even life-threatening, acute response within hours [5,6,8,14]. Also, the presence of eosinophilia and eosinophiluria could be supportive of hypersensitivity, but urinary eosinophils are currently considered as a test with poor sensitivity and low positive predictive value, with its absence not excluding the diagnosis [7,8,[15][16][17]. Eosinophilia is present in only 25%-50% of acute interstitial nephritis cases.…”

“…Eosinophilia is present in only 25%-50% of acute interstitial nephritis cases. A list of kidney diseases associated with eosinophilia should be considered in the differential diagnosis including Allergic interstitial nephritis, Transplant rejection, Cholesterol embolic disease, Vasculitis, Diffuse proliferative glomerulonephritis, Thrombotic thrombocytopenic purpura and Renovascular disease [7,8,[15][16][17].…”

Uveitis in Children: Diagnosis and Management

“…Uveitis can also be seen in systemic lupus erythematosus and many vasculitides like Kawasaki disease. Tubulointerstitial nephritis-uveitis (TINU) syndrome is a rare cause of anterior uveitis in older children and as the name suggests, has tubulointerstitial nephritis in association [19]. Behçet's syndrome typically causes posterior uveitis and retinal vasculitis [20].…”

Management of extrapulmonary sarcoidosis: challenges and solutions

“…GCs are the mainstay of treatment in interstitial nephritis, and are often very effective 36. They have also been used successfully in hypercalcemia and hypercalciuria, although many times discontinuation of vitamin D supplements is sufficient to normalize calcium levels 30.…”