Tubulointerstitial nephritis, acute and chronic form: symptoms, causes and treatment

Tubulo-interstitial nephritis is referred to as widespread kidney disease and canal lesions, leading to impairment of organ function. The disease is characterized by a vast change in the structure of interstitial kidney tissues. There are two types of disease course - acute and chronic. In the instruction of many medications entering the human body, it is mentioned that the medicine is excreted through the kidneys. Unthinking and uncontrolled admission of medications leads to the onset of the disease due to allergies to certain medicines or herbal therapies. The ailment also arises as a consequence of the transferred infection.

To identify tubulointerstitial nephritis, the methods of modern research of the body are used, namely: ultrasound, urine and blood analysis, data collection of anamnesis, kidney biopsy. The conclusion regarding the reversibility of the disease is made on the basis of the severity of the damage and the timing of seeking medical help.

Causes of disease

Sometimes the administration of antibiotics or other anti-inflammatory drugs is prolonged for a long time. And kidney damage occurs after severe poisoning with chemicals, heavy metals. Especially harmful are pairs of ethanol. Tubulointerstitial nephritis can arise because of a variety of reasons:

• After the transferred viral infection - in 46% of cases;
• Toxic allergic manifestations provoke the disease in 28.3%;
• Metabolic disorders in the body contribute to the emergence of the disease in 13.9%;
• Disorders of the circulatory function of the ureters - 8.8%;
• Genetic and immune causes - in 0.9% of diseases;
• Several reasons are immediately observed in 2.5% of cases.

Chronic forms of the disease are caused by serious disruption of the integrity of the cytoplasm, dysplasia of the kidney tissues, changes in metabolism, congenital and acquired anomalies of the ureters.

Establishing diagnosis

A number of physical and laboratory studies are being conducted. And only then an accurate diagnosis is made. Tubulointerstitial nephritis is assumed in a patient with the appearance of expressive symptoms, which are diagnosed by independent physical manifestations.

Disease of a chronic nature is a consequence of infiltration and atrophy of canals in the human body for a long time. Function of the organ is inhibited gradually - for several years. The patient consults the doctor when unpleasant symptoms appear, such as kidney pain, rash and others. They give him considerable discomfort. The disease affects two kidneys at once or damages only one.

In urine laboratory examination, a urinary sediment with a large content of erythrocytes and leukocytes is clearly visible. In this case, there is a complete absence of erythrocytes of the dysmorphic type and only a slight manifestation of hematuria. The presence of eosinophils in the urine does not characterize the presence of the disease, since only in 50% of cases they are a consequence of the ailment. If they are not at all, then this indicates that the disease is absent. Proteinuria is revealed by minimal indicators, but if the organism has already developed glomerular pathology caused by the use of antibiotics, then this indicator reaches the nephrotic level.

In the blood test, acute tubulointerstitial nephritis manifests itself as hypercalcemia. Violation of the function of the channels leads to metabolic acidosis. With ultrasound, the echogenicity index is much higher due to the development of the body's swelling and the infiltration process. Ultrasound shows an increase in the size of the kidneys, an increase in the indicator of radioactive gallium and leukocytes, noted in the process of radionuclides. A positive scan indicates tubulointerstitial nephritis. Diagnosis, which revealed a negative result, should be confirmed by other methods.

Symptomatology of the disease

At the first stages of the disease, symptoms do not appear. Some patients do not know about developing pathology. Later terms of the course of the disease make themselves felt by expressive signs:

• There are eruptions partially or on the entire surface of the body, which have an itchy character;
• Increases in a small range of temperature, severe cases are noted feverish condition;
• Pain in the kidneys is felt constantly or frequent passing bouts;
• Fatigability increases, the patient feels rolling drowsiness;
• Pressure jumps occur for no apparent reason;
• There is polyuria.

Many different manifestations of tubulointerstitial nephritis. Symptoms are observed in the form of fever and rash, but these changes in the body are not enough to make a diagnosis. Rash occurs a month after the action of the toxin or for 3-6 days. It depends on the state of the body and its reaction to the allergen. There is a loss of weight, pain in the abdomen and in the back area above the buttocks.

The disease, which has passed into the chronic stage, differs at some period with mild symptoms that increase with time. Some people develop nocturia and polyuria. Increased blood pressure and swelling of the limbs are not observed until there is a kidney failure. Symptoms described in the list are typical for the acute stage of the disease.

Chronic nephritis

The disease passes into a chronic form after an acute course. But such cases are rare. Most often, chronic nephritis develops after the infection, persistent metabolic disorders in the body, permanent drug intoxication. Chronic tubulointerstitial nephritis on ultrasound examination shows the glomerulus in the normal state or destroyed. The tubules are not completely or deformed. There are different channel lumens - from narrowed to wide with homogeneous shells.

Renal tissue is susceptible to fibrosis and inflammatory processes. If there is a lot of fibrosis, then the parenchyma looks almost healthy. Atrophied kidneys have a small size and signs of asymmetry. Symptoms of chronic nephritis are similar to those present in the acute stage, but have a less pronounced manifestation. Leukocytosis and an increase in the level of red blood cells are rare. Chronic course of the disease is very dangerous, so you need to listen carefully to the symptoms in the early stages of the disease. Untimely treatment leads to kidney failure, which is fraught with big troubles.

Acute course of the disease

Often occurs due to improper self-treatment without consulting a doctor. The inability of the kidneys to perform their functions, the emergence of acute inflammatory processes appear after a long time of use in the treatment of beta-lactamide antibiotics.

Acute nephropathy is characterized by the presence of peripheral edema and inflammatory infiltration. They spread to the kidney tissue. Before the onset of severe symptoms, it sometimes takes several weeks. Then acute renal failure develops , which is provoked by untimely initiation of treatment and the continuing impact of the irritating factor.

Baby jade

The opportunity to avoid the development of the disease in childhood becomes timely treatment to the doctor in case of any ailments, starting with colds. Do not self-medicate, only a practicing pediatrician will pick up medicines that do not harm the child's immune system that has not formed.

Tubulointerstitial nephritis in children is treated under the supervision of a specialist. In parallel, a therapeutic diet is prescribed, without which positive results are more difficult to achieve. In case of neglected jaw, the diseased kidney can not be cured, then the organ is transplanted. For children, the wavy course of the disease with a long latent period is characteristic.

Prognosis of the disease

If the kidney function is impaired due to the use of medications, tubulointerstitial nephritis occurs. Treatment in mild cases is not required. Stop taking medication, and the kidneys begin normal work after 2-2,5 months. Sometimes the residual phenomenon is the presence of scars. When a disease of another etiology eliminates the cause, but the disease is reversible. In severe cases, kidney failure and fibrosis remain.

The prognosis of the chronic form of nephritis depends on the speed of detection and reduction of pathology before an irreversible form of fibrosis appears. If it is impossible to correct genetic, toxic and metabolic changes, the ailment turns into thermal renal failure.

Treatment of the disease

At the first symptoms of the disease you need to see a doctor. Only he will choose the right and competent treatment. Therapy for each patient is individual. But, for example, to accelerate the recovery in the acute stage of the disease, and sometimes chronic, use glucocorticoids. Brakes the process of taking angiotensin blockers, inhibitors.

Kidney biopsy

The procedure refers to diagnostic measures for the detection of kidney disease. It is the taking of a piece of tissue for microscopic examination. A small amount of kidney material is collected through a thin syringe needle. Such a study helps to effectively determine the chemical composition of the tissue and choose the optimal method of treatment.

Indications for the biopsy procedure

The biopsy method is used in the following cases:

• Until the end it is not possible to find out the cause of a chronic or acute disease.
• There is a suspicion of jade.
• Renal failure is rapidly progressing.
• There is a complex infectious etiology.
• In laboratory tests of urine, an admixture of blood and protein was detected.
• A blood test shows a large amount of uric acid, creatinine, urea.
• Suspected oncology.
• The transplanted kidney functions with problems.
• There is a need to determine the degree of damage.
• To monitor the course of treatment.

Biopsy specimens

The procedure is done through the skin. It is carried out with a prick above the kidneys and is monitored by x-ray or ultrasound. To facilitate the finding of an organ in the veins, a neutral color contrasting in color is introduced. An open biopsy procedure is characterized by taking a small amount of tissue directly during surgery. For example, when the removal of an oncologic neoplasm takes place. The procedure is indicated for those who have bleeding or there is only one kidney in working condition. This is done to reduce the risk of exposure to it.

Joint biopsy with urethroscopy is performed in the presence of stones in the ureter or renal pelvis. It is done in the operating room and represents the introduction of a flexible tube for internal examination of the ureter. The transplant type of biopsy is the insertion of a catheter into the selected renal vein. It is used in patients with obesity, chronic insufficiency of breathing and poor blood clotting, when none of the above methods is performed because of a threat to life and does not reveal tubulointerstitial nephritis.

In conclusion, it should be said that a disease that at first glance proceeds without symptoms that do not disturb the patient, in fact, needs to be identified in time. Complicated and untreated nephritis weakens kidney function and leads to irreversible consequences.