Acute Nephritis tubulointerstitial - Causes, Symptoms and Treatment .MF .
This disease is not as rare as you can think about it.And the diagnosis is not always placed precisely and not always on time.This information will be useful to doctors, to the sudden worsening of kidney function in patients included in the list of possible causes and this pathology and patients who turn to the doctor on time and do not forget to mention that still could provoke disease.
Acute interstitial nephritis (acute tubulointerstitial nephrit
thus affects not the glomeruli from the "inside", and the tissue that surrounds them and must protect the idea.However, the tissue (interstitial) swells, interferes with the operation of the glomeruli and tubules, causing renal function deteriorates.
Causes of acute tubulointerstitial nephritis
What triggers the disease, what is the reason?Acute tubulointerstitial nephritis occurs under the action of a provoking factor (drugs, infection).The exact mechanism interstitial nephritis development is unknown, there is evidence for its immune origin, in some way can be regarded as a hypersensitivity reaction (for example, some drugs) in individuals.
most common cause of tubulointerstitial nephritis is taking certain medications.The spectrum of these drugs is very broad, such as drug acute tubulointerstitial nephritis can cause drugs such as antibiotics, nonsteroidal anti-inflammatory agents, diuretics, antihistamines, allopurinol, aspirin, azathioprine, captopril, diazepam, Chinese medicinal herbs used for weight loss.Most often, of course, of the drugs acute interstitial nephritis provoke various nonsteroidal anti-inflammatory drugs (so-called tablets "from the tooth, from headaches and back pain").
development of the disease does not depend on the dose of the drug, and to predict the possibility of a human reaction to the drug in the form of acute interstitial nephritis can not be, unless the patient has had similar episodes in history.In the presence of risk factors (liver disease, kidney disease, hyponatremia and hypovolemia, previous treatment with diuretics, heart failure, immunological disease, condition after surgery, older age) the incidence of acute interstitial nephritis increases.
also cause the development of tubulointerstitial nephritis may be bacterial and viral infections (diphtheria, Brucella, Legionella, Campylobacter, Toxoplasma, Mycoplasma, Rickettsia, syphilis, leptospirosis, cytomegalovirus).
If not diagnosed because of the disease talking about idiopathic tubulointerstitial nephritis.
Symptoms of acute tubulointerstitial nephritis
Start acute, manifested through 1-30 days after the beginning of exposure to the etiological factor (cause).There is a thirst, often polyuria (large amounts of urine), rash (petechial or maculo-papular), fever, and sometimes pain in the lumbar region.Rarely can appear edema and decreased urine until her absence (anuria).Edema and large amounts of protein in the urine is more common acute tubulointerstitial nephritis caused by the intake of non-steroidal anti-inflammatory drugs.When nephritis other etiologies edema often absent.
Self diagnosis is extremely difficult, it is necessary to see a specialist (physician, nephrologist) and pass a number of tests to be examined.Be sure to talk with your doctor to point out all the factors that could trigger the disease: Taking drugs ported infections, the use of various herbs and teas for weight loss and for other purposes.
What is necessary to establish the correct diagnosis?
for the diagnosis of acute tubulointerstitial nephritis is necessary to make a number of analyzes:
• CBC - as a rule, the disease is accompanied by eosinophilia, anemia.There may also be signs of inflammation such as the leukocytosis and increased ESR.
• Biochemical analysis of blood - indicates damage to the kidney tissue and determines the severity of the lesion.Symptoms: increased level of urea and creatinine, often - increased transaminases blood, changes in blood electrolyte composition, metabolic acidosis.
• Urinalysis - low density of urine, proteinuria, hematuria, cylindruria.
• ultrasound of the kidneys - kidneys normal or increased in size.
• If necessary - perform nefrobiopsii.Morphologically: interstitial inflammation with eosinophils, lymphocytic infiltration of the tubules, necrosis of tubular epithelium.
Treatment of acute tubulointerstitial nephritis
compulsory hospitalization of the patient in the hospital.
Firstly, you need to stop the drug that caused the disease (analgesics, antibiotics, etc.), Or to cease contact with toxins.It is important to use the liquid in sufficient quantity.Next, the correction of disorders caused by impaired renal function: correction of acidosis (soda solution intravenously in the hospital), correction of anemia (iron supplements, erythropoietin), blood pressure normalization (peroralnyeantigipertenzivnye drugs), correction of fluid and electrolyte disorders (hypokalemia, hyperkalemia).Treatment of acute renal failure itself: diuretics intravenously (Lasix);preparations improving renal blood flow (pentoxifylline, trental, aminophylline), antihistamines (suprastin, tavegil).
In the absence of effect of the treatment for 7 days, or with an increase in renal failure is considered an option initiation of therapy with glucocorticosteroids - prednisone 30-40 mg / day to 60 mg / day for 2-3 weeks, in severe cases - pulse -therapy 1000mg / every 3 days, with further reduction in the dosage and cancellation.
Treatment of folk remedies and herbs is fraught with even greater worsening of renal function, since it is unknown how inflamed interstitium of kidney tissue will react to various bioflavonoids concentrated broths.
Typically, during treatment with renal failure resolved within a month.
When treatment failure and build-up of renal failure: oliguria continues, the symptoms of uremia grow 5-7 days, increased potassium levels over 6.5 mmol / l, metabolic acidosis, is not amenable to correction, creatinine level greater than 0.7 mmol / L increaseshyperhydration with clinical and radiographic manifestations of pulmonary edema - the patient is transferred to the intensive care unit and hemodialysis sessions are held.In the future, the treatment is carried out as usual.
the treatment recommended bed rest, light diet with restriction of salt.
Possible complications of acute tubulointerstitial nephritis
Without timely adequate treatment possible pulmonary edema;a transition of the disease into a chronic form.When qualified treatment, good patient response to treatment and the abolition of provoking drugs kidney function is restored in full.
After discharge, the patient needs medical check-up for 5 years:
Inspection nephrologist 2 times a year (in the clinic or the city center of Nephrology).Control blood tests (clinical, biochemical), urine.Med.otvod vaccination 1-2 years.Rehabilitation of chronic foci of infection (treatment of caries, tonsillectomy, the treatment of chronic pyelonephritis and adnexitis, etc.)
Employability patients after recovery is fully restored.In the case of chronic renal insufficiency, the incidence of patient surveys increased to 4-6 times a year.
prevention of acute tubulointerstitial nephritis
is difficult to predict how it will react and at the moment the human body.Against the background of unfavorable ecological situation and the mass introduction of various drugs, their availability and active advertising - all this leads to sometimes uncontrolled reception of medicines that people appoint themselves.
Knowing all this, you must be careful to treat your body and perform a series of rules:
1) Avoid unknown drugs that have not been certified in the Russian market, for example, all sorts of supplements, Chinese herbs and teas for weight loss, "magic capsule"healing of all.
2) Do not abuse drugs, even the most "harmless".Do not at any pains to make powerful non-steroidal anti-inflammatory agent, especially a daily basis.If something bothers much better to solve this problem together with your doctor.
3) Do not take diuretics alone, thinking that in this way get rid of the swelling and look slimmer.These drugs - only in agreement with your doctor.
4) When you see some reaction to the drug in the form of a rash, swelling, fever should immediately seek medical attention.
5) Maintain a healthy lifestyle, adhere to proper nutrition, pills are not abused, but if the drug is prescribed by a doctor by prescription, take it as recommended, to preserve their health.
Article written by a physician nephrologist