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Chronic tubulointerstitial nephritis
Last reviewed: 23.04.2024
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Causes of the chronic tubulointerstitial nephritis
Chronic tubulointerstitial nephritis (dosage form), unlike many other variants of chronic nephropathy, is potentially preventable. Most of his cases are associated with long-term intake of NSAIDs and non-narcotic analgesics; to refer to them use the term analgesic nephropathy.
The development of analgesic chronic tubulointerstitial nephritis is caused by chronic blockade of the synthesis of renal prostaglandins under the influence of NSAIDs and non-narcotic analgesics, accompanied by a significant deterioration of renal hemodynamics with ischemia of predominantly tubulointerstitial structures. Progressing tubulo-interstitial inflammation and fibrosis lead to irreversible impairment of kidney function. In addition, a characteristic feature of analgesic nephropathy is the calcification of the renal papillae. The pronounced carcinogenic effect is attributed to N-hydroxylated metabolites of phenacetin.
Symptoms of the 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.
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Diagnostics of the chronic tubulointerstitial nephritis
Diagnosis of chronic tubulointerstitial nephritis requires a detailed familiarization with an anamnesis. When analgesic nephropathy is still at the preclinical stage, in most patients, when performing Zimnitsky's trial, a depression of the relative density of urine is detected. A moderate urinary syndrome is characteristic (microhematuria, moderate proteinuria). A significant increase in the excretion of proteins with urine indicates the development of severe glomerular lesions (more often - focal segmental glomerulosclerosis), predicting the development of terminal renal failure.
Accession of the macrohematuria is a sign of developing necrosis of the renal papillae; at its preservation it is necessary to exclude uroepithelial carcinoma, the risk of which with analgesic nephropathy is very high, especially in smokers. Analgesic nephropathy is characterized by aseptic ("sterile") leukocyturia.
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What tests are needed?
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Treatment of the chronic tubulointerstitial nephritis
Treatment of chronic tubulointerstitial nephritis requires consideration of the presence of concomitant factors that can enhance the severity of kidney damage:
- chronic heart failure;
- diabetes mellitus type 2;
- disturbances of uric acid metabolism.
In the elderly, a combination of several forms of kidney damage ("multimorbidity"), for example, analgesic and urate, diabetic nephropathy, as well as ischemic kidney disease and chronic pyelonephritis, is possible.