Disease Information for Nephritis, analgesic, interstitial

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Clinical Manifestations
Signs & Symptoms
High blood pressure/sign
Excess Thirst in Elderly
Excessive thirst/polydipsia
Dry mouth/Mucous membranes
Muscle weakness
Headache/chronic recurrent
Nocturia
Nocturia in Elderly
Acutely ill patient/signs
Chills
Thirst Increased
Weakness
Clinical Presentation & Variations
AIDS with Renal failure
Disease Progression
Course/Chronic disorder
Course/Chronic only
Demographics & Risk Factors
Established Disease Population
Patient/On Medications long term/ usually
Patient/Peptic ulcer disease
Patient/Depression, chronic
Laboratory Tests
Microbiology & Serology Findings
Microlab/Sterile urine
Abnormal Lab Findings (Non Measured)
URINE Isosthenuria/mid-range SPGR
Renal function abnormalities (Lab)
URINE Dipstick /Blood abnormal
URINE Dipstick/Leukocytes Positive
URINE Pyuria
URINE Pyuria with negative cultures
URINE Sediment/Urinalysis abnormal
URINE Specific gravity fixed/1.010
Abnormal Lab Findings - Decreased
BUN/Creatinine ratio (Lab)
Creatine clearance (Lab)
URINE Specific gravity
Abnormal Lab Findings - Increased
BUN/Blood urea nitrogen (Lab)
Creatinine, serum (Lab)
Fractional excretion Sodium (Lab)
Potassium, serum (Lab)
URINE Casts/Protein casts
URINE Eosinophiles
URINE Epithelial/round cells
URINE Leukocyte casts
URINE Leukocytes
URINE Protein (Albumin)
URINE Red blood cells
URINE Sodium
Diagnostic Test Results
Pathology
BX/Renal Abnormal
BX/Renal Cortex tubulointerstitial nephritis/acute
CT Scan
CT Scan/Renal (Kidney) Abnormal
CT Scan/Renal without contrast/Abnormal
CT Scan/Renal/Bumpy contours indentations cortex
CT Scan/Renal/No contrast/Papillary calcifications.
CT Scan/Renal/No contrast/Small kidneys
X-RAY With contrast
IVP/Decreased dye visualization/bilateral
IVP/Papillary destruction/amputation
Ultrasound
Ultrasound/Renal/Kidneys echogenic cortex bilateral
Associated Diseases & Rule outs
Associated Disease & Complications
Acute Tubulointerstitial Nephropathy
Azotemia/Acute
Drug induced Nephritis/Nephropathy
Hydronephrosis
Hyperkalemia
Hypertension
Hypertensive heart disease
Hypervolemia
Isosthenuria syndrome
Kidney stone/Nephrolithiasis/Urolithiasis
Nephritis tubulointerstitial
Nephritis, analgesic/interstitial
Nephritis, interstitial
Nephritis, non-allergic interstitial
Nephritis, secondary
Nephrogenic diabetes insipidus
Peptic ulcer disease
Proteinuria
Pyelonephritis, acute
Renal colic
Renal Failure Chronic
Renal papillary necrosis
Renal tubular acidosis, distal
Renal tubule acidosis, acquired
Toxic nephritis/Chronic persistent
Toxic Nephritis/Nephropathy
Ureter obstruction
Hematuria
Proteinuria in Elderly
Pyuria
Disease Mechanism & Classification
Class
CLASS/Renal/kidney involvement/disorder (ex)
CLASS/Urologic (category)
Pathophysiology
Pathophysiology/Defective Potassium excretion/renal
Pathophysiology/Renal concentration capacity defect
Process
PROCESS/Drug induced disorder (ex)
PROCESS/Medication/Drug (CONFIRM dose/before treatment)
PROCESS/Poisoned organ/system (category)
Synonyms
Synonym
Analgesic nephropathy, Analgesic nephropathy (disorder), drug nephropathy analgesic, NEPHROPATHY ANALGESIC, Synonym/Acute tubulointerstitial nephritis syndrome, Synonym/Analgesic nephropathy
Treatment
Drug Therapy - Indication
SX/Renal biopsy
Definition

Diagnosis: Fever; Transient maculopapular rash; Acute renal insufficiency; Pyuria (including eosinophiluria), white blood cell casts, and hematuria; Acute interstitial nephritis accounts for 10-15% of cases of intrinsic renal failure; An interstitial inflammatory response with edema and possible tubular cell damage is the typical pathologic finding; Cell-mediated immune reactions prevail over humoral responses; T lymphocytes can cause direct cytotoxicity or release lymphokines that recruit monocytes and inflammatory cells; Although drugs account for over 70% of cases, acute interstitial nephritis also occurs in infectious diseases, immunologic disorders, or as an idiopathic condition; The most common drugs are penicillins and cephalosporins, sulfonamides and sulfonamide-containing diuretics, NSAIDs, rifampin, phenytoin, and allopurinol; Infectious causes include streptococcal infections, leptospirosis, cytomegalovirus, histoplasmosis, and Rocky Mountain spotted fever; Immunologic entities are more commonly associated with glomerulonephritis, but systemic lupus erythematosus, Sjögren"s syndrome, sarcoidosis, and cryoglobulinemia can cause interstitial nephritis; Clinical features can include fever (> 80%), rash (25- 50%), arthralgias, and peripheral blood eosinophilia (80%); The urine often contains red cells (95%), white cells, and white cell casts; Proteinuria can be a feature, particularly in NSAID-induced interstitial nephritis but is usually modest; Eosinophiluria can be detected by Wright"s or Hansel"s stain; Acute interstitial nephritis often carries a good prognosis; Recovery occurs over weeks to months, but acute dialytic therapy may be necessary in up to one-third of all patients before resolution; Patients rarely progress to ESRD; Those with prolonged courses of oliguric failure and advanced age have a worse prognosis; Treatment consists of supportive measures and removal of the inciting agent; If renal failure persists after these steps, a short course of corticosteroids can be given; Short-term, high-dose methylprednisolone 4 days or prednisone 2 weeks followed by a prednisone taper can be used in these more severe cases of drug-induced interstitial nephritis; [CMDXRX2005]------------------.Analgesic variant includes triggers of acetaminophen, propoxyphene and NSAIDS usually; clinically same as with other causes;

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Harrison's Online (accessmedicine)
NEJM (The New England Journal of Medicine)
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