Vol. 13. Núm. 81.
Páginas 4765-4773 (Junio 2023)

Actualización
Enfermedades renales tubulointersticiales. Nefritis intersticial aguda

Tubulointerstitial kidney diseases. Acute interstitial nephritis

C. Vega-CabreraaB. Rivas BecerraaE. García FernándezbG. Fernández-Juáreza
Doi : https://10.1016/j.med.2023.06.001
Opciones
Resumen

La nefritis intersticial aguda (NIA) está caracterizada por un infiltrado inflamatorio, edema y tubulitis en el intersticio renal que habitualmente condiciona un deterioro agudo de la función renal. La NIA se refiere a la forma aguda de la enfermedad que presenta un rápido deterioro de la función renal, mientras que las formas crónicas tienen un curso más prolongado, con mayor fibrosis detectada mediante histología. Por lo tanto, el diagnóstico definitivo de ambas patologías es histológico, ya que en la actualidad no se dispone de marcadores no invasivos para su confirmación o exclusión. La incidencia exacta es muy difícil de establecer, pero oscila entre un 5%-27%, con un incremento progresivo de la incidencia principalmente en ancianos, lo que puede reflejar una mayor exposición de los pacientes de edad avanzada a fármacos y otros factores desencadenantes. Actualmente las causas de la NIA han cambiado drásticamente, siendo ahora los agentes farmacológicos la etiología más común (más del 75%).

Palabras clave
Nefritis Intersticial aguda
AINE
Uveítis
TINU
Antibiótico
Síndrome Dress
Abstract

Acute interstitial nephritis (AIN) is characterised by an inflammatory infiltrate, oedema and tubulitis in the renal interstitial, and it usually leads to acute deterioration of kidney function. AIN refers to the acute form of the disease which causes swift deterioration of kidney function, while the chronic forms have a longer course in which histology detects more fibrosis. The definitive diagnosis of both pathologies is therefore histological, as there are currently no non-invasive markers to confirm or exclude them. Although its exact incidence is very hard to determine, it varies from 5%-27%, progressively increasing in incidence mainly in the elderly, which may be due to their increasing exposure to drugs and other trigger mechanisms. The causes of AIN have undergone a drastic change, as now the most common aetiology consists of pharmacological agents (more than 75%).

Keywords
Acute Interstitial nephritis
AINE
Uveitis
TINU
Antibiotic
Dress syndrome

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Bibliografía
[1]
F. Caravaca-Fontán
202306131057264158
202306131057264159
, G. Fernández-Juárez, M. Praga.
Acute kidney injury in interstitial nephritis.
Curr Opin Crit Care., (2019), 25 pp. 558-564
[2]
M. Praga
2023061310572641510
, E. González.
Acute interstitial nephritis.
Kidney Int., (2010), 77 pp. 956-966
[3]
M. Praga
2023061310572641511
2023061310572641512
, A. Sevillano, P. Aunon, E. González.
Changes in the aetiology, clinical presentation and management of acute interstitial nephritis, an increasingly common cause of acute kidney injury.
Nephrol Dial Transplant., (2015), 30 pp. 1472-1479
[4]
G.M. Fernández Juárez
2023061310572641513
, J. Villacorta Pérez, F. Caravaca Fontan, C. Cases Corana, B. Sánchez Alamo, A.M. Tato Ribera.
Nuevos retos en las nefritis tubulointersticiales inducidas por fármacos.
Nefrología., (2019), 39 pp. 339-342
[5]
M.A. Perazella
2023061310572641514
2023061310572641515
.
Diagnosing drug-induced AIN in the hospitalized patient: a challenge for the clinician.
Clin Nephrol., (2014), 81 pp. 381-388
[6]
C.C. Nast
2023061310572641516
.
Medication-Induced Interstitial Nephritis in the 21st Century.
Adv Chronic Kidney Dis., (2017), 24 pp. 72-79
[7]
M.A. Perazella
2023061310572641517
2023061310572641518
, G.S. Markowitz.
Drug-induced acute interstitial nephritis.
Nat Rev Nephrol., (2010), 6 pp. 461-470
[8]
D.G. Moledina
2023061310572641519
, M.A. Perazella.
PPIs and kidney disease: from AIN to CKD.
J Nephrol., (2016), 29 pp. 611-616
[9]
F.B. Cortazar
2023061310572641520
2023061310572641521
, K.A. Marrone, M.L. Troxell, K.M. Ralto, M.P. Hoenig, J.R. Brahmer, et al.
Clinicopathological features of acute kidney injury associated with immune checkpoint inhibitors.
Kidney Int., (2016), 90 pp. 638-647
[10]
H. Seethapathy
2023061310572641522
2023061310572641523
, S. Herrmann, M. Sise.
Immune checkpoint inhibitors and kidney toxicity: Advances in diagnosis and management.
Kidney Med., (2021), 3 pp. 1074-1081
[11]
R. Díaz-Mancebo
2023061310572641524
, O. Costero-Fernández, C. Vega-Cabrera, T. Olea-Tejero, L. Yébenes, M.L. Picazo, et al.
Dress syndrome and acute tubulointerstitial nephritis after treatment with vancomycin and beta-lactams. Case report and literature review.
[12]
J.A. Rossert
2023061310572641525
2023061310572641526
, E.A. Fischer.
Acute interstitial nephritis.
Comprenhensive clinical nephrology, 6ª ed, Elsevier, pp. 729-737
[13]
K. Tanaka
2023061310572641527
, K. Tanabe, N. Nishii.
Sustained tubulointerstitial inflammation in kidney with severe leptospirosis.
Ann Inter Med., (2017), 56 pp. 1117-1184
[14]
T. Outinen
2023061310572641528
, S. Makela, J. Clement, A. Pakkala.
Community acquired severe acute kidney injury caused by hantavirus induced hemorrhagic fever with renal syndrome has a favorable outcomes.
Nephron., (2015), 130 pp. 182-190
[15]
S. Rubin
2023061310572641529
2023061310572641530
, A. Orieux, R. Prevel, A. Garric, M.L. Bats, S. Dabernat, et al.
Characterization of acute kidney injury in critically ill patients with severe coronavirus disease 2019.
Clin Kidney J., (2020), 13 pp. 354-361
[16]
N. Oliva-Damaso
2023061310572641531
, E. Oliva-Damaso, J. Payan.
Acute and chronic tubulointerstitial nephritis of rheumatic causes.
Rheum Dis Clin North Am., (2018), 44 pp. 619-633
[17]
M.P. Paroli
2023061310572641532
, D. Cappiello, D. Staccini, R. Caccavale, M. Paroli.
Tubulointerstitial nephritis and uveitis syndrome (TINU): A case series in a tertiary care uveitis setting.
J Clin Med., (2022), 11 pp. 4995
[18]
N. Joss
2023061310572641533
, S. Morris, B. Young.
Granulomatous interstitial nephritis.
Clin J Am Soc Nephrol., (2007), 2 pp. 222-230
[19]
M. Mahévas
2023061310572641534
, F.X. Lescure, J.J. Boffa, V. Delastour, X. Belenfant, C. Chapelon, et al.
Renal sarcoidosis: clinical, laboratory, and histologic presentation and outcome in 47 patients.
Medicine (Baltimore)., (2009), 88 pp. 98-106
[20]
M. Brause
2023061310572641535
, K. Magnusson, S. Degenhardt, U. Helmchen, B. Grabensee.
Renal involvement in sarcoidosis a report of 6 cases.
Clin Nephrol., (2002), 57 pp. 142-148
[21]
N. Joss
2023061310572641536
, S. Morris, B. Young, C. Geddes.
Granulomatous interstitial nephritis.
Clin J Am Soc Nephrol., (2007), 2 pp. 222
[22]
Y. Mori
2023061310572641537
, N. Kishimoto, H. Yamagata.
Predominant tubulointerstitial nephritis in a patient with systemic lupus nephritis.
Clin Exp Nephrol., (2005), 9 pp. 79-84
[23]
A. Broder
2023061310572641538
, W.B. Mowrey, H.N. Khan, B. Jovanovic, A. Londono-Jiménez, P. Izmirly, et al.
Tubulointerstitial damage predicts end stage renal disease in lupus nephritis with preserved to moderately impaired renal function: A retrospective cohort study.
Semin Arthritis Rheum., (2018), 47 pp. 545-551
[24]
C. Morrondo
2023061310572641539
, J.M. Lema, N. Álvarez, A. Atanes, F. de Toro.
Aspectos actuales del síndrome de Sjögren: etiopatogenia, manifestaciones clínicas, diagnóstico y tratamiento.
Semin Fund Esp Reumatol., (2010), 11 pp. 70-76
[25]
S. Maripuri
2023061310572641540
, J.P. Grande, T.G. Osborn, F.C. Fervenza, E.L. Matteson, J.V. Donadio, et al.
Renal involvement in primary sjögren's syndrome: A clinicopathologic study.
Clin J Am Soc Nephrol., (2009), 4 pp. 1423-1431
[26]
H. Francois
2023061310572641541
, X. Mariette.
Renal involvement in primary Sjogren syndrome.
Nat Rev Nephrol., (2016), 12 pp. 82-93
[27]
M. Matignon
2023061310572641542
, P. Cacoub, M. Colombat, D. Saadoun, I. Brocheriou, B. Mougenot, et al.
Clinical and morphologic spectrum of renal involvement in patients with mixed cryoglobulinemia without evidence of hepatitis C virus infection.
Medicine., (2009), 88 pp. 341-348
[28]
J.C. Jennette
2023061310572641543
, R.J. Falk.
The pathology of vasculitis involving the kidney.
Am J Kidney Dis., (1994), 24 pp. 130-141
[29]
N. Sakai
2023061310572641544
, T. Wada, M. Shimizu, C. Segawa.
Tubulointerstitial nephritis with anti-neutrophil cytoplasmic antibody following indomethacin treatment.
Nephrol Dial Transplant., (1999), 14 pp. 2774
[30]
X. He
2023061310572641545
, Y. Wen, R. Hu, H. Wu, W. Ye, C. Yue, et al.
Interstitial nephritis without glomerulonephritis in ANCA-associated vasculitis: a case series and literature review.
Clin Rheumatol., (2022), 41 pp. 3551-3563
[31]
T. Saeki
2023061310572641546
, M. Kawano, T. Nagasawa, Y. Ubara, Y. Taniguchi, M. Yanagita, et al.
Validation of the diagnostic criteria for IgG4-related kidney disease (IgG4-RKD) 2011, and proposal of a new 2020 version.
Clin Exp Nephrol., (2021), 25 pp. 99-109
[32]
J. Baltar Martin
2023061310572641547
, C. García-Monteavaro.
Afectación renal de las enfermedades relacionadas con IgG4.
NefroPlus., (2015), 7 pp. 1-10
[33]
R. Raghavan
2023061310572641548
, S. Shawar.
Mechanisms of drug-induced interstitial nephritis.
Adv Chronic Kidney Dis., (2017), 24 pp. 64-71
[34]
E.G. Nielson
2023061310572641549
.
Pathogenesis and therapy of interstitial nephritis.
Kidney Int., (1989), 35 pp. 1257-1270
[35]
R. Raghavan
2023061310572641550
, G. Eknoyan.
Acute interstitial nephritis—A reappraisal and update.
Clin Nephrol., (2014), 82 pp. 149-162
[36]
A.S. Bomback
2023061310572641551
2023061310572641552
, G.S. Markowitz.
Increased prevalence of acute interstitial nephritis: more disease or simply more detection.
Nephrol Dial Transplant., (2013), 28 pp. 16-18
[37]
Y. Wu
2023061310572641553
2023061310572641554
, L. Yang, T. Su, C. Wang, G. Liu, X. Li.
Pathological significance of a panel of urinary biomarkers in patients with drug-induced tubulointerstitial nephritis.
Clin J Am Soc Nephrol., (2010), 5 pp. 1954-1959
[38]
D.G. Moledina
2023061310572641555
, C.R. Parikh.
Differentiating acute interstitial nephritis from acute tubular injury: A challenge for clinicians.
Nephron., (2019), 212 pp. 1-6
[39]
Moledina
2023061310572641556
DG, Wilson FP, Pober JS, Perazella MA, Singh N, Luciano RL, et al. Urine TNF-α and IL-9 for clinical diagnosis of acute interstitial nephritis. 2019;4(10):e127456. doi: 10.1172/jci.insight.127456.
[40]
A.K. Muriithi
2023061310572641557
, S.H. Nasr, N. Leung.
Utility of urine eosinophils in the diagnosis of acute interstitial nephritis.
Clin J Am Soc Nephrol., (2013), 8 pp. 1857-1862
[41]
G.B. Fogazzi
2023061310572641558
, B. Ferrari, G. Garigali, P. Simonini, D. Consonni.
Urinary sediment findings in acute interstitial nephritis.
Am J Kidney Dis., (2012), 60 pp. 330-332
[42]
M.A. Perazella
2023061310572641559
2023061310572641560
.
Clinical approach to diagnosing acute and chronic tubulointerstitial disease.
Adv Chronic Kidney Dis., (2017), 24 pp. 57-63
[43]
D. Qualls
2023061310572641561
, H. Seethapathy, H. Bates, S. Tajmir, P. Heidari, P. Endres, et al.
Positron emission tomography as an adjuvant diagnostic test in the evaluation of checkpoint inhibitor-associated acute interstitial nephritis.
J Immunother Cancer., (2019), 7 pp. 356
[44]
G. Fernández-Juárez
2023061310572641562
2023061310572641563
, J.V. Pérez, F. Caravaca-Fontán, L. Quintana, A. Shabaka, E. Rodríguez, et al.
Duration of treatment with corticosteroids and recovery of kidney function in acute interstitial nephritis.
Clin J Am Soc Nephrol., (2018), 13 pp. 1851-1858
[45]
E. González
2023061310572641564
, E. Gutiérrez, C. Galeano, C. Chevia, P. de Sequera, C. Bernis, et al.
Early steroid treatment improves the recovery of renal function in patients with drug-induced acute interstitial nephritis.
Kidney Int., (2008), 73 pp. 940-946
[46]
D.C. Preddie
2023061310572641565
, G.S. Markowitz, J. Radhakrishnan, T.L. Nickolas, V.D. D’Agati, J.A. Schwimmer, et al.
Mycophenolate mofetil for the treatment of interstitial nephritis.
Clin J Am Soc Nephrol., (2006), 1 pp. 718-722