- Book学术

发布求助

文献互助智能选刊最新文献

IF 2.2 4区医学 Q2 UROLOGY & NEPHROLOGY

BMC Nephrology Pub Date : 2025-02-25 DOI:10.1186/s12882-025-04030-5

Mohammad Alsultan, Marwa Kliea, Qussai Hassan

{"title":"Acute tubulointerstitial nephritis (ATIN) including drug-induced, tubulointerstitial nephritis and uveitis (TINU), ANCA-associated vasculitis (AAV), kidney- limited sarcoidosis, and hemolysis: a case series from Syria.","authors":"Mohammad Alsultan, Marwa Kliea, Qussai Hassan","doi":"10.1186/s12882-025-04030-5","DOIUrl":null,"url":null,"abstract":"Background: This study aimed to detail acute tubulointerstitial nephritis (ATIN) patients, from relevant clinical manifestations to outcomes.Methods: We reviewed ATIN patients between 2018 and 2022. All demographic data, labs, biopsy findings, treatment protocols, and outcomes were reported.Results: ATIN was diagnosed in nine patients, eight by kidney biopsy and one clinically. Drug-induced ATIN (DI-ATIN) was reported in five patients, including rifampin (RIF), allopurinol, mesalamine, and two with cephalosporins. Severe ATIN resulted after the first dose of RIF aligned with liver injury, hemolysis, and thrombocytopenia. Also, mesalamine and allopurinol induced gradual kidney failure a few months after the drug initiation. A patient with Tubulointerstitial nephritis and uveitis (TINU) syndrome showed refractory uveitis presenting during glucocorticoids (GCs) tapering, which resolved quickly with azathioprine (AZA) when not responding to GCs reescalation. Among the rarest cases, ATIN induced by a kidney-limited sarcoidosis, G6PD patient with hemolysis induced ATIN, and isolated ATIN induced by ANCA-associated vasculitis (AAV) with positive C-ANCA, which the latter representing the first case in our country and the fourth case worldwide. Labs showed anemia (88.8%), ESR elevation (85.7%), microscopic hematuria (in all patients), pyuria (44.4%), and proteinuria (77.7%). Biopsies showed interstitial infiltrations mainly with lymphocytes and monocytes. Eosinophils were found in one biopsy and neutrophils showed in 4 biopsies (50%).Conclusion: ATIN is a disease with a diagnostic challenge, thus clinicians should maintain a high suspicion for diagnosis. The combination of AKI with positive tests (especially abnormal urine sediment, ESR elevation, and anemia) may suggest ATIN diagnosis and further support the treatment initiation, particularly when kidney biopsy is unable to be performed or when the inciting agent is predictable.","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"97"},"PeriodicalIF":2.2000,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11853720/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMC Nephrology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s12882-025-04030-5","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}

引用次数: 0

摘要

背景：本研究旨在详细了解急性肾小管间质性肾炎（ATIN）患者从相关临床表现到预后的情况：本研究旨在详细介绍急性肾小管间质性肾炎（ATIN）患者从相关临床表现到预后的情况：我们回顾了2018年至2022年间的ATIN患者。报告了所有人口统计学数据、实验室检查、活检结果、治疗方案和结果：9名患者确诊为ATIN，其中8人通过肾活检确诊，1人通过临床确诊。有五名患者报告了药物诱发的 ATIN（DI-ATIN），包括利福平（RIF）、别嘌呤醇、美沙拉明，以及两名使用头孢菌素的患者。首次服用利福平（RIF）后出现严重的 ATIN，并伴有肝损伤、溶血和血小板减少。此外，美沙拉明和别嘌醇也会在用药几个月后诱发渐进性肾衰竭。一名患有肾小管间质性肾炎和葡萄膜炎（TINU）综合征的患者在糖皮质激素（GCs）减量期间出现难治性葡萄膜炎，在对GCs减量无效时，使用硫唑嘌呤（AZA）可迅速缓解。在最罕见的病例中，有肾局限性肉芽肿病诱发的ATIN、G6PD患者溶血诱发的ATIN，以及ANCA相关性血管炎（AAV）诱发的C-ANCA阳性的孤立性ATIN，后者是我国首例、全球第四例。实验室检查显示贫血（88.8%）、血沉增快（85.7%）、镜下血尿（所有患者均有）、脓尿（44.4%）和蛋白尿（77.7%）。活组织检查显示间质浸润，主要是淋巴细胞和单核细胞。一项活检发现嗜酸性粒细胞，4 项活检发现中性粒细胞（50%）：ATIN是一种诊断困难的疾病，因此临床医生在诊断时应保持高度怀疑。AKI合并阳性检查（尤其是尿沉渣异常、血沉升高和贫血）可提示ATIN诊断，并进一步支持开始治疗，尤其是在无法进行肾活检或诱因可预测的情况下。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Acute tubulointerstitial nephritis (ATIN) including drug-induced, tubulointerstitial nephritis and uveitis (TINU), ANCA-associated vasculitis (AAV), kidney- limited sarcoidosis, and hemolysis: a case series from Syria.

Background: This study aimed to detail acute tubulointerstitial nephritis (ATIN) patients, from relevant clinical manifestations to outcomes.

Methods: We reviewed ATIN patients between 2018 and 2022. All demographic data, labs, biopsy findings, treatment protocols, and outcomes were reported.

Results: ATIN was diagnosed in nine patients, eight by kidney biopsy and one clinically. Drug-induced ATIN (DI-ATIN) was reported in five patients, including rifampin (RIF), allopurinol, mesalamine, and two with cephalosporins. Severe ATIN resulted after the first dose of RIF aligned with liver injury, hemolysis, and thrombocytopenia. Also, mesalamine and allopurinol induced gradual kidney failure a few months after the drug initiation. A patient with Tubulointerstitial nephritis and uveitis (TINU) syndrome showed refractory uveitis presenting during glucocorticoids (GCs) tapering, which resolved quickly with azathioprine (AZA) when not responding to GCs reescalation. Among the rarest cases, ATIN induced by a kidney-limited sarcoidosis, G6PD patient with hemolysis induced ATIN, and isolated ATIN induced by ANCA-associated vasculitis (AAV) with positive C-ANCA, which the latter representing the first case in our country and the fourth case worldwide. Labs showed anemia (88.8%), ESR elevation (85.7%), microscopic hematuria (in all patients), pyuria (44.4%), and proteinuria (77.7%). Biopsies showed interstitial infiltrations mainly with lymphocytes and monocytes. Eosinophils were found in one biopsy and neutrophils showed in 4 biopsies (50%).

Conclusion: ATIN is a disease with a diagnostic challenge, thus clinicians should maintain a high suspicion for diagnosis. The combination of AKI with positive tests (especially abnormal urine sediment, ESR elevation, and anemia) may suggest ATIN diagnosis and further support the treatment initiation, particularly when kidney biopsy is unable to be performed or when the inciting agent is predictable.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

BMC Nephrology UROLOGY & NEPHROLOGY-

CiteScore

4.30

自引率

0.00%

发文量

375

审稿时长

3-8 weeks

期刊介绍： BMC Nephrology is an open access journal publishing original peer-reviewed research articles in all aspects of the prevention, diagnosis and management of kidney and associated disorders, as well as related molecular genetics, pathophysiology, and epidemiology.