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Pathology- Acute drug-induced interstitial nephritis
Definition: Renal impairment resulting from a hypersensitivity reaction to a medication.
Epidemiology • Rare.
Aetiology • Nonsteroidal anti-inflammatory drugs (NSAIDs). • Antimicrobials. • Diuretics. • Allopurinol. • Proton pump inhibitors.
Pathogenesis: A hypersensitive reaction to the offending medication induces tubulointerstitial inflammation and tubular destruction. The usual presentation is acute respiratory failure accompanied by fever and rash. Numerous patients have eosinophilia, eosinophiluria, and elevated serum IgE levels. • Patients with NSAID-induced conditions may exhibit significant proteinuria. • Typically, symptoms manifest within days of initiating the medication, although in other instances, they may not appear until many months of exposure.
Macroscopy • The kidneys exhibit swelling, pallor, and increased weight.
Histopathology • The interstitium exhibits expansion due to edema and a heterogeneous inflammatory cell infiltrate, prominently including eosinophils, which may lead to the formation of eosinophilic microabscesses. • Lymphocytes are additionally observed infiltrating the tubules, a condition referred to as 'tubulitis.'
Prognosis: The discontinuation of the causative medication typically leads to full recovery.
Definition: Renal impairment resulting from a hypersensitivity reaction to a medication.
Epidemiology • Rare.
Aetiology • Nonsteroidal anti-inflammatory drugs (NSAIDs). • Antimicrobials. • Diuretics. • Allopurinol. • Proton pump inhibitors.
Pathogenesis: A hypersensitive reaction to the offending medication induces tubulointerstitial inflammation and tubular destruction. The usual presentation is acute respiratory failure accompanied by fever and rash. Numerous patients have eosinophilia, eosinophiluria, and elevated serum IgE levels. • Patients with NSAID-induced conditions may exhibit significant proteinuria. • Typically, symptoms manifest within days of initiating the medication, although in other instances, they may not appear until many months of exposure.
Macroscopy • The kidneys exhibit swelling, pallor, and increased weight.
Histopathology • The interstitium exhibits expansion due to edema and a heterogeneous inflammatory cell infiltrate, prominently including eosinophils, which may lead to the formation of eosinophilic microabscesses. • Lymphocytes are additionally observed infiltrating the tubules, a condition referred to as 'tubulitis.'
Prognosis: The discontinuation of the causative medication typically leads to full recovery.
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