DRUG ASSOCIATED ACUTE INTERSTITIAL NEPHRITIS - CLINICAL AND PATHOLOGICAL FEATURES AND THE RESPONSE TO HIGH-DOSE STEROID-THERAPY

  • 1 January 1983
    • journal article
    • research article
    • Vol. 52  (206) , 194-211
Abstract
Episodes [9] of drug associated acute interstitial nephritis were treated in 7 patients. The drugs implicated were cotrimoxazole (3 times), ampicillin, Magnapen (ampicillin and flucloxacillin), penicillin, gentamicin, paracetamol and bendrofluazide. The time from exposure to the onset of symptoms was 1-30 days. Presentation was with acute renal failure, which was non-oliguric in 5 cases, accompanied by rash (4), fever (4) and loin pain (2). Renal biopsy was carried out in all cases, and showed a characteristic interstitial infiltrate comprising substantial numbers of lymphocytes and plasma cells, with a variable number of neutrophils, eosinophils and histiocytes. Immunofluorescence was negative in all 4 cases studied in the acute phase, and showed scattered deposits of IgG, IgM, IgM, IgA and C3 on the tubular basement membrane in 1 patient during recovery. Significant proteinuria and an abnormal urine deposit were present in all cases, and 7 of 5 had radiological evidence of enlarged kidneys. Seven episodes were treated with high doses of methyl prednisolone and in all there was a response with a diuresis or spontaneous fall in serum creatinine within 72 h, and recovery of virtually normal renal function. Of 2 cases who did not initially receive steroids, 1 improved more slowly and 1 developed chronic renal impairment.

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