Acute interstitial nephritis is responsible for more than 15% of cases of acute kidney injury. However, unlike many other conditions accompanied by similar phenomena, recovery is achieved in 50% of patients in conditions of early diagnosis and timely treatment.
However, a prolonged inflammatory process can lead to irreversible renal failure. According to statistics, 40-60% of cases of acute interstitial nephritis can lead to the development of chronic renal failure. Despite this, the delay in the diagnosis of this acute condition is considered one of the main predictors of incomplete recovery of kidney function.
Read the article on estet-portal.com the most relevant approaches to the diagnosis of nephritisand its impact on the development of renal failure.
Nephritis and chronic renal failure
Recent studies have shown that at least 2-3% of cases of chronic kidney disease may be the result of undiagnosed acute interstitial nephritis as a result of the prescription of proton pump inhibitors. With this in mind, non-invasive biomarkers could be the key to timely diagnosis, thereby improving care for patients with suspected acute interstitial nephritis and thus reducing the incidence of chronic kidney disease.
Follow us on Instagram!
The main task in the diagnosis of acute interstitial nephritis is the need to differentiate this condition from other causes of an acute increase in serum creatinine. For the first time, the clinical description of this pathology was associated with the use of β-lactam antibiotics, such as methicillin, and was characterized by typical signs of an allergic reaction − fever, rash and eosinophilia shortly after taking the drug.
However, current studies have shown that at present, the etiological factors in the development of this pathology are usually not β-lactam antibiotics, proton pump inhibitors, non-steroidal anti-inflammatory drugs and antitumor immunotherapy.
Manifestations of acute interstitial nephritis against the background of the use of these drugs do not have characteristic signs, which leads to loss of time and limits the predictable diagnostic search.
Jade diagnostic methods
Clinically available tests such as urinary sediment microscopy for eosinophilia and imaging tests are of low diagnostic weight. As a result, one of the most reliable diagnostic methods remains a biopsy of the tissues of the kidney − invasive method, associated with risks and not always feasible for some patients with renal insufficiency. But even such an invasive method is not distinguished by the absolute accuracy of histological interpretation due to the absence of stable signs of interstitial changes.
Cytokines in the diagnosis of acute interstitial nephritis
In a new study by scientists, the thesis was taken as a basis that acute interstitial nephritis is a hypersensitivity reaction to the use of a drug. Based on this, the authors suggested that this pathological process will be accompanied by the expression of a certain type of CD4 + T cells, the activation of which is mediated by the releasing of characteristic cytokines, such as IFN-.gamma. and IL-2 (type 1); IL-4, IL-5 and IL-13 (Type 2) or IL-9 (Type 9).
Researchers have suggested that specific cytokine patterns will be higher precisely due to acute interstitial nephritis compared to other causes of acute elevation of serum creatinine, such as in renal failure.
Thus, in a cohort of patients with acute interstitial nephritis, confirmed by the results of a biopsy of renal tissues, according to the conclusions of three pathologists, and a group of patients with other pathological conditions, accompanied by an increase in serum creatinine, a study was made of the spectrum of cytokines in blood plasma and urine for the subject of possible identification of some of them as diagnostic markers of acute interstitial nephritis.
Peculiarities of using diuretics in renal failure
A multivariate analysis of 12 selected urinary and plasma cytokines was used in the study to identify those that differed by feature in a cohort of patients with biopsy-proven acute interstitial nephritis. According to the results of the analysis, it was found that patients with this pathology had consistently high levels of TNF-α; and IL-9 in urine compared to a group of participants with other diagnoses, including kidney failure, acute tubular and glomerular injury, diabetic kidney disease, and those who did not have any kind of kidney failure.
According to the researchers, the accuracy of diagnosis based on biopsy data is about 100%, taking into account the human factor. But considering the results of the analysis, IL-9 had a fairly high comparative rating of 84%, and this figure is significantly higher than the 62-69% diagnostic accuracy based on isolated clinical data.
Urinary incontinence in women: why it happens
Summarizing, the authors noted that the next step in scientific research should be to test the preliminary results in a larger study, which could form the basis in developing an evidence base for the presentation of TNF-α; and IL-9 as a complementary, next to biopsy, diagnostic tool for acute interstitial nephritis.
At the same time, the researchers expressed their confidence that later, it is biomarkers that will be able to completely replace invasive biopsy, providing the clinician with the possibility of early diagnosis, and the patient − hope for the timely prevention of complications in the form of renal failure.
Urinary syndrome: as evidenced by changes in urine values
Share:
Add a comment