Urinary Sediment Findings in Acute Interstitial Nephritis

Fogazzi, Giovanni B.; Ferrari, Barbara; Garigali, Giuseppe; Simonini, Paola; Consonni, Dario

doi:10.1053/j.ajkd.2012.05.002

Cited by 57 publications

(47 citation statements)

References 7 publications

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“…However, in other forms of DAIN, pyuria is noted in ,50% of cases (15,18). Fogazzi et al recently described urinary findings in 21 patients with biopsy-proven DAIN (19). On urine microscopy, leukocytes and RBCs were found in only 12 and 9 patients, respectively, confirming the previously reported rates.…”

Section: Dainsupporting

confidence: 59%

“…Other urinary sediment findings include RTECs, RTEC casts, and granular casts, reflecting tubular injury and necrosis. In the series of Fogazzi et al, many hyaline and granular casts (18 of 21) were described in DAIN, further supporting renal tubular injury by the inflammatory process (19). Surprisingly, RBC casts were noted in 6 of 21 patients and WBC casts in only 3 of 21 patients (19).…”

Section: Dainmentioning

confidence: 95%

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AKI in a Hospitalized Patient with Cellulitis

Perazella

2013

Clinical Journal of the American Society of Nephrology

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Summary AKI occurs commonly in hospitalized patients with multiple comorbidities. In this Attending Rounds, a woman with AKI in the setting of an infection, use of antibiotics and other medications, bacteremia, and hypotension is considered. Such patients lead to a broad differential diagnosis for AKI including prerenal AKI, acute tubular injury/acute tubular necrosis, infection-related GN, and drug-induced acute interstitial nephritis. The roles of an accurate history, physical examination, laboratory data, and kidney biopsy are highlighted in establishing the correct diagnosis in such patients.

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Section: Dainsupporting

confidence: 59%

Section: Dainmentioning

confidence: 95%

AKI in a Hospitalized Patient with Cellulitis

Perazella

2013

Clinical Journal of the American Society of Nephrology

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“…Recent report about the analysis of the urinary sediment in NTIA cases, surprisingly found that: RBC casts were noted in 26% of the cases and WBC casts in only 14% of the case of drug-induced ATIN [21]. Furthermore, although urine concentrations of sodium (Na), urea and creatinine either examined alone or as fractional excretions (FE) of Na (FENa) or urea (FEurea) are largely used to asses patients with AKI, save some exceptions, they just have greatest utility in distinguish pre-renal AKI from acute tubular necrosis (ATN), but they are not useful in evaluation of ATIN (Perazella 2014).…”

Section: Discussionmentioning

confidence: 96%

“…However, in other forms of drug-induced ATIN, leukocytes are noted in about 50% or even less of the cases. Although there are many studies that con irm haematuria and leukocyturia as common inding; Physicians should not mistakenly exclude ATIN as a cause of AKI in the absence of either haematuria or sterile pyuria (with or without eosinophils) [18,21].…”

Section: Discussionmentioning

confidence: 99%

Acute Tubulointerstitial Nephritis due to Phenytoin: Case Report

Bresolin¹

2017

J Clini Nephrol

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SUMMARYIntroduction: Acute tubulointerstitial nephritis (ATIN) is an acute kidney injury (AKI) resulting from damage to the tubulointerstitial tissue due to infection, trauma, or use of medication. It is clinically non-specifi c.Case: A teenager with multiple trauma, hospitalised after lowering of level of conscience, and convulsion fi ts. While in the emergency ward, he received: midazolam, fentanyl and phenytoin. The cranial and abdominal CT scans were normal. He was stable with no signs of shock, trauma or infection; he developed oliguria and serum creatinine (Scr) 1.7mg/dL), 12 hours after the admission. After 36 hours, Scr levels were at 3.4mg/dL and urea at 55mg/dL. He had AKI according to pRIFLE (66.2% reduction in clearance). After other causes of AKI had been ruled out, the possibility of ATIN was raised; the phenytoin was suspended and pulse therapy, with methylprednisolone, was promptly initiated. After the fi rst pulse, there was already a decline in the creatinine and urea readings; 48 hours later: Scr at 2.2mg/dL and urea at 86mg/dL. Thirty days after being discharged from hospital, the patient was in good health and had full restoration of kidney function. Discussion:The singularity of this report relies on the rarity of ATIN secondary to the use of phenytoin and also in the importance of recognizing this aetiology as being one of the origins of AKI. Conclusion:Early diagnosis allows the reversal of AKI through suppression of treatment with phenytoin and introduction of corticosteroid therapy, when necessary.

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“…Brought to you by | MIT Libraries Authenticated Download Date | 5/12/18 7:43 PM casts can also be present, in variable amounts, in all renal diseases, including glomerulonephritides, where they have been found in 100% of the patients investigated [15], and acute interstitial nephritis, in which they have been observed in 86% of cases [16]. Most importantly, whilst in the normal subjects and in the other non-renal conditions mentioned above, hyaline casts are the only urinary finding, in renal disorders hyaline casts are almost invariably associated with other types of casts and urine sediment particles [15,16].…”

Section: Hyaline Castsmentioning

confidence: 99%

Cylindruria

Caleffi

Lippi

2015

Clinical Chemistry and Laboratory Medicine (CCLM)

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Abstract:The morphological analysis of urine sediment is an essential part of urinalysis and casts are important elements of urinary sediment. Their shape is typically cylindrical, with extremities often rounded. Casts form within the renal tubules and are made of Tamm-Horsfall glycoprotein (THG). Under some physiological or pathological conditions THG fibrils aggregate giving rise to casts, whose formation is favoured by a number of factors including high urine osmolality and/or low pH. Casts can be found in normal subjects, in non-renal conditions, such as fever, dehydration, and acute heart failure as well as in virtually all renal diseases. Casts can be classified on the basis of their morphology as hyaline, granular, waxy, fatty, cellular (leukocytic, erythrocytic, epithelial), containing crystals or microorganisms, pigmented and mixed. As the correct identification of casts is crucial for an accurate and timely diagnosis of renal disorders, laboratory professionals should be trained to identify and classify casts properly.

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Urinary Sediment Findings in Acute Interstitial Nephritis

Cited by 57 publications

References 7 publications

AKI in a Hospitalized Patient with Cellulitis

AKI in a Hospitalized Patient with Cellulitis

Acute Tubulointerstitial Nephritis due to Phenytoin: Case Report

Cylindruria

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