Interstitial nephritis is a disease characterized by inflammation of the kidney tissues and tubules. This disease can develop as a result of a past infection. In addition, it can be formed due to the use of certain medications. The appearance of this disease is often affected by metabolic disorders, intoxication, and in addition, the formation of malignant tumors. Such a phenomenon as interstitial nephritis occurs in acute or chronic form. Next, we find out what symptoms and manifestations accompany the development of this disease in humans. And also find out what kind of treatment is carried out.
Basic information about the disease
So, interstitial nephritis is an inflammatory pathology of the kidneys, which has a non-infectious abacterial nature. In the presence of this disease, pathological processes occur in the interstitial tissues and affect the tubularnephron apparatus.
This disease is considered an independent nosological form. It differs from pyelonephritis, first of all, in that in the presence of pathology, any destructive changes in the renal tissues do not occur, that is, the inflammation process does not extend to the region of the calyces and pelvis.
Interstitial nephritis (ICD 10 N 11.0) can manifest itself at absolutely any age. It can even occur in newborns or among elderly patients. But most often this disease is registered in the age category from twenty to fifty years. The clinic of interstitial nephritis is characterized by a decrease in the functionality and performance of the renal tubules, in connection with this, the presented pathology can be called tubulointerstitial nephritis or tubulointerstitial nephropathy.
Acute and chronic disease
Acute interstitial nephritis usually presents as inflammation of the interstitial tissues. In more severe cases, this process can provoke the development of kidney failure. True, this disease has a predominantly favorable prognosis.
Chronic interstitial nephritis is characterized by fibrosis of the interstitial tissues, damage to the glomeruli, and in addition, tubular atrophy. The chronic type of the disease leads to nephrosclerosis. This form of the disease can cause chronic kidney failure.
Interstitial nephritis occurs in children.
According to the development mechanism, the following forms are distinguished:
- Primary. In this casethe pathological process develops in the renal tissue on its own, and not against the background of another disease.
- Secondary. It develops against the background of an already existing kidney disease and greatly complicates its course. It can also develop due to the presence of leukemia, diabetes, gout and other diseases in the body.
Main causes of pathology
The main causes of this disease include a number of different factors, for example:
- Use for the treatment of all kinds of drugs. We are talking about antibiotics, fluoroquinolones, nonsteroidal drugs, sulfonamides, diuretics, for example, the use of Penicillin, Ampicillin, Cephalotin, Gentamicin, Ibuprofen, Captopril, Naproxen, and so on.
- Past infectious pathologies that are caused by various bacteria, such as streptococcus or diphtheria.
- Past illnesses caused by viruses, such as cytomegalovirus or hemorrhagic fever.
- The presence of diseases of the immune system, for example, the development of systemic lupus erythematosus.
- Development of multiple myeloma.
- Heavy metal poisoning such as lead, mercury, cadmium, etc.
- Human metabolic disorder.
In the event that the underlying cause of interstitial nephritis remains unclear, then it is called idiopathic. Now let's find out what symptoms accompany this disease.
Symptoms of disease
Clinical symptoms of interstitial nephritis directly depends on the degree of intoxication, and in addition, on the level of intensity of the disease. Symptoms of the acute form of this pathology usually appear three days after the onset of infectious diseases, such as, for example, tonsillitis, tonsillitis, influenza, sinusitis, and so on. Also, symptoms may appear after the use of antibiotics, medicinal serums and diuretics.
Most often, patients with chronic interstitial nephritis experience weakness along with lethargy, loss of appetite, nausea, or vomiting. Often, all these symptoms can be accompanied by an increase in body temperature. Muscle pain, an allergic skin rash, and a slight increase in pressure are also possible.
For the acute form of interstitial nephritis, urination is not characteristic and edema does not occur. Exceptionally in extremely severe cases of this disease, patients may have a decrease in the amount of urine. This can occur up to the complete cessation of urinary flow, thus developing anuria.
The symptoms of interstitial nephritis are very unpleasant.
From the first days, patients may also develop renal failure of varying severity, however, with adequate treatment, these manifestations are quite reversible. They usually go away after a couple of weeks. The concentration function of the kidneys most often normalizes after three months.
Symptoms of interstitial nephritis also depend onforms of disease.
Disease forms
In addition to the main forms of the disease (acute and chronic), this pathology is further subdivided into the following four types:
- Development of an extended form of interstitial nephritis. At the same time, the patient has all the clinical symptoms of the disease.
- Against the background of a severe form, manifestations of acute kidney failure along with prolonged anuria can be expressed.
- With the development of the abortive form, patients do not have anuria, and, in addition, a favorable course of the disease is observed along with a rapid restoration of kidney function.
- With the development of a focal form, a mild clinical symptomatology of interstitial nephritis is observed. There may be polyuria, which will be expressed in excessive formation of urine. This type of disease is characterized by a favorable course, with which patients recover quickly.
It should be noted that chronic nephritis differs from the acute form in a more unfavorable course. In the later stages of the disease, changes in the functioning of the kidneys are noted, and glomerulosclerosis develops. At the same time, the development of chronic kidney failure is also possible.
Among the symptoms of interstitial nephritis in adults, wave fever is often observed along with allergic itchy rash, lower back pain, anuria or polyuria, dry mouth and thirst, increased pressure and anemia. The development of glomerulosclerosis can lead to edema and proteinuria. Therapy prognosisthe chronic form of interstitial nephritis directly depends on the rate of development of kidney failure. In addition, the prognosis depends on the degree of damage to the renal tangles.
Mechanisms of acute nephrotoxicity
Specialists identify five mechanisms of nephrotoxicity in the development of acute interstitial nephritis:
- The process of redistribution of renal blood flow along with its reduction.
- Development of ischemic damage to glomerular and tubular basement membranes.
- The onset of a delayed hypersensitivity reaction.
- The process of directly attacking tubular cells by enzymes in the presence of anoxia.
- Development of selective cumulation in the kidneys.
The pattern of tubular dysfunction can vary greatly depending on the location of the lesion.
Recommendations for interstitial nephritis will be given below.
Diagnosis of this pathology
As part of the diagnosis of this disease, the following methods of examining the patient are taken:
- Conducting an analysis of the patient's complaints along with the collection of an anamnesis of the disease.
- Research of complete blood count.
- Carrying out a biochemical analysis of urine.
- Sampling of Zimnitsky and Roberg.
- Performing a serological test.
- Performing a study to determine the specific microglobulins present in the urine.
- Urine culture to identify anddefinition of bacteria.
- Performing a kidney ultrasound.
- Renal biopsy.
In addition to the above research methods, other diagnostic methods may be carried out at the discretion of the attending physician.
Treatment of the disease
Early diagnosis is extremely important for the treatment of interstitial nephritis, along with the abolition of medications that provoke the development of this disease. Whenever possible, the number of drugs used should be reduced by replacing them with nephrotoxic agents and non-toxic drugs. Against the background of polyuria, the volume of fluid consumed should be increased, and with oliguria, on the contrary, reduced. Patients with oligoanuria are prescribed hemodialysis, which helps restore kidney function. If necessary, a short course of glucocorticoid treatment is carried out, and in addition, cytostatics are used.
The treatment prognosis for acute interstitial nephritis is generally favorable. Direct recovery of patients occurs in a few weeks, in extreme cases, it takes a couple of months. Against the background of a slow recovery of kidney function and with prolonged anuria, acute interstitial nephritis can become chronic.
The development of the chronic form of the disease necessarily requires the restoration of the patient's water and electrolyte metabolism. Among other things, measures are being taken to eliminate the causes of damage to the interstitium. Also, therapy is aimed at normalizing the functions of the urinary tract. In addition, therapy is being carried out to treat chronic kidney failure.
Clinical guidelines for interstitial nephritis should be strictly followed.
Disease treatment program
Treatment of such a problem should be aimed at eliminating provoking factors and restoring renal function. Thus, therapy is carried out according to the following scheme:
- Exclusion of causal factors that cause the development of the chronic nature of the disease. To do this, you should completely cancel the drugs that caused the pathological processes.
- In the event that there are no symptoms of chronic pyelonephritis, then patients are prescribed a physiologically complete diet that can provide a sick person with the necessary amount of carbohydrates, proteins, fats and, of course, vitamins. It is equally important to limit the patient in the use of table s alt. This is especially useful in the presence of high blood pressure.
- Performing symptomatic treatment of interstitial nephritis. Such therapy should include the use of drugs called Enalapril. This drug is able to favorably affect renal hemodynamics, thanks to which the level of proteinuria decreases.
- You should also prescribe steroid hormones. This is especially true if the nephritis has progressed rapidly or is extremely severe.
- Carrying out adjustments in the body of lowsodium and potassium levels as a result of too frequent urination.
- The use of medicines that improve the state of microcirculation. For example, in this case, patients should be prescribed drugs in the form of Curantil and Troxevasin.
Possible complications in the development of pathology
Against the background of the development of such a disease as interstitial nephritis (ICD N 11.0), patients are likely to experience the following complications:
- Acute or chronic kidney failure.
- Occurrence of arterial hypertension.
- Development of a chronic form of nephritis.
Prevention of this pathology
As part of the prevention of this disease, it is advisable to follow the following recommendations:
- Use of drinking plenty of water.
- Total avoidance of prolonged use of drugs that are potentially harmful to the kidneys.
- Perform regular urine testing.
- Implementation of sanitation of any chronic foci of infection.
- It is very important to try to avoid hypothermia. Thus, it is necessary to observe the thermal regime.
- It is very important to conduct a study of urine against the background of each disease. Among other things, this should be done before and after various preventive vaccinations.
- A person should monitor the state of his body and prevent excessive overwork and frequent fatigue. Therefore, excessive physical activity should be avoided.loads.
In the event of any symptoms that may indicate the appearance of interstitial nephritis, it is urgent to contact a therapist, and in addition to such specialists as a nephrologist or urologist. Delayed treatment may turn out to be ineffective, as a result of which all vital renal functions will be disrupted, while the development of failure of this organ is not ruled out, which means that there is a direct threat to the patient's life.
