Chronic tubulointerstitial nephritis: symptoms

Chronic drug tubulointerstitial nephritis

[1], [2], [3], [4], [5]

Analgesic nephropathy

The extrarenal symptoms of chronic tubulointerstitial nephritis (analgesic nephropathy), including the drug allergic triad, are not characteristic of NSAIDs.

Targeted detection of dependence on NSAIDs and non-narcotic analgesics allows early recognition of analgesic nephropathy or even prevent it. The group of especially high risk are elderly patients. All clinical guidelines that allow suspected chronic analgesic tubulointerstitial nephritis are combined by the term "large analgesic syndrome".

Relatively early clinical signs of analgesic nephropathy are considered to be thirst and polyuria. Patients often observe violations of acidification of urine, some of them form renal tubular acidosis, manifested by muscle weakness, episodes of seizures, as well as nephrolithiasis, calcification of the renal papillae and osteodystrophy.

Great analgetic syndrome

System of organs	Symptoms
GIT	Stomach ulcer and duodenal ulcer (especially with repeated gastrointestinal bleeding)
Blood System	Iron deficiency and macrocytic anemia Leukopenia
The cardiovascular system	Arterial hypertension Common atherosclerosis
CNS	Migraine Sleep disorders (insomnia) Abuse of alcohol, sleeping pills, drugs
Sexual system	Violation of libido Infertility
"General" signs	Premature aging Malicious smoking Characteristics of personality (hypochondriacal type)

Patients with chronic analgesic tubulointerstitial nephritis are prone to infections of the urinary tract, the bowl is flowing with the erased clinical picture.

A typical symptom of analgesic nephropathy is arterial hypertension, sometimes difficult to control. Secondary metabolic disorders develop: hyperuricemia is most typical, also contributing to increased blood pressure.

Criteria for the diagnosis of analgesic nephropathy:

• "The Big."
  • Daily intake of analgesics for more than 1 year.
  • Reducing the volume of the kidneys, the unevenness of their contours, calcification in the brain substance with ultrasound or CT.
• "Small".
  • The presence of any chronic pain syndrome.
  • Stomach ulcer and 12 duodenal ulcer in anamnesis.
  • Personality features - depression, a tendency to hypochondria.
  • Clinical signs of chronic tubulointerstitial nephritis.
  • "Sterile" leukocyturia.

[6], [7], [8], [9], [10], [11]

Chronic tubulointerstitial nephritis

Chronic tubulointerstitial nephritis is one of the variants of nephrotoxic action of cyclosporin and tacrolimus. Characterized by hypertension and slowly progressive renal failure. The risk of renal tubulointerstitia in the administration of tacrolimus is less than that of cyclosporine.

Chronic tubulointerstitial nephritis is observed in patients taking Chinese herbs, in particular collections intended for the treatment of obesity, and also used as immunomodulators. Some patients noted the rapid development of terminal renal failure. Impaired renal function of varying severity was observed in all patients. In the diagnosis, great importance is given to a detailed knowledge of the anamnesis. Chronic tubulointerstitial nephritis associated with the use of Chinese herbs containing aristocholic acid is a relatively new form of tubulointerstitial nephropathy, characterized by certain clinical features:

• The first symptom is often renal failure, including severe;
• a significant tubular dysfunction is characteristic;
• proteinuria, as a rule, is small;
• blood pressure often remains normal;
• aristolochievic acid has a carcinogenic effect on the urinary tract.

[12], [13], [14], [15]

Chronic tubulointerstitial nephritis due to environmental factors

Chronic tubulointerstitial nephritis is observed in 3-20% of patients taking long-term lithium preparations. At least 20% of them develop nephrogenic diabetes insipidus with characteristic polydipsia and polyuria.

When taking lithium drugs, it is possible to develop a nephrotic syndrome, in most cases regressing when they are withdrawn. Acute renal failure is observed with severe intoxication with lithium. The course of the disease is relatively benign: the development of terminal renal failure is not described.

Variants of kidney damage caused by lithium intoxication:

• chronic tubulointerstitial nephritis;
• renal diabetes insipidus;
• renal tubular acidosis;
• nephrotic syndrome;
• acute renal failure.

There are two variants of lesions of renal tubulointerstitium, caused by lead intoxication. Fanconi syndrome, combined with hyperuricemia and eosinophilic protein complexes in urine containing lead, is more often observed in children who received large doses of lead for a short time. The signs of kidney damage are usually reversible when contact with lead is eliminated.

Long-term intoxication with small doses of lead is accompanied by the development of chronic tubulointerstitial nephritis. Progression of renal failure is slow, tubulointerstitial fibrosis is usually not very pronounced.

Typical signs of chronic lead tubulointerstitial nephritis are arterial hypertension and metabolic disorders of uric acid. Hyperuricemia is often very pronounced and is accompanied by attacks of typical gouty arthritis ("lead" gout). The frequency of kidney cancer in workers who have been in contact with lead for a long time has been increased.

For cadmium damage of the kidneys, there are signs of pronounced tubular dysfunction, polyuria. Part of the patients observed arterial hypertension. Renal impairment, as a rule, is minimal, but cases of terminal renal failure are known.

There are several variants of radiation nephropathy. Characteristic clinical features - the possibility of the appearance of signs of kidney damage after a long time (sometimes years) after exposure to ionizing radiation and progression even after contact has been removed from it. A typical symptom of radiation nephropathy is arterial hypertension, usually difficult to control, often of malignant course.

[16], [17]

Chronic tubulointerstitial nephritis in systemic diseases

Chronic sarcoid tubulointerstitial nephritis is found in patients with chronic sarcoidosis with other extrapulmonary symptoms of this disease. Symptoms are nonspecific, arterial hypertension is not mandatory symptom. Renal failure in chronic sarcoid tubulointerstitial nephritis, as a rule, is moderately or more often absent, cases of irreversible deterioration of renal function are extremely rare. Single observations of recurrence of the disease in a renal transplant are described. In most patients, calcium metabolism disorders are asymptomatic, but at least 5% develop nephrolithiasis and nephrocalcinosis.

[18], [19], [20], [21], [22]