Diseases of the renal system are not uncommon. They deliver a lot of problems to patients, and with wrong or untimely treatment can lead to serious complications such as kidney failure, etc. One of the dangerous kidney pathologies that can disable the patient's ability to work is interstitial nephritis.
Interstitial nephritis
Interstitial( or tubulointerstitial) nephritis is considered to be a pathology of inflammatory origin, affecting tubules and interstitial tissue of the kidneys. The disease develops against the backdrop of metabolic disorders, infectious processes or intoxication.
According to the international classification, the pathology is assigned the ICD-10 code:
- Acute interstitial nephritis - N10;
- Chronic interstitial nephritis - N11.
The disease is considered very common and resembles pyelonephritis in symptoms, only with interstitial nephritis there is no tissue destruction, and the inflammatory process affects only the connective tissue structures, from which a kind of organ skeleton is formed, and does not affect the cup-and-pelvic system. Pathology occurs in patients of different ages from small children to the elderly, but still more often pathology occurs in 20-50-year-old patients.
Forms of
Interstitial kidney nephritis is classified into several varieties. According to the development mechanism, the pathology can be:
- Primary - when the disease is formed by itself;
- Secondary - when interstitial nephritis occurs against the background of already existing renal pathology, worsening the flow pattern. In addition, secondary forms of the disease have such causes as diabetes, leukemia, gout, etc.
By nature, interstitial nephritis is divided into:
- Chronic - this form is characterized by the development of fibrotic changes in the tissues from which the stroma is formed. Gradually, tubular necrosis occurs, then the glomeruli filtering the blood are affected. In the absence of the necessary medical care, there is a great chance of developing nephrosclerosis, when there is an irreversible violation of renal functions, which is deadly. Provoke chronic interstitial nephritis can autoimmune pathologies and disorders in the formation of kidney tissues, urinary anomalies and granulomatous inflammatory pathologies, prolonged use of NSAIDs or painkillers;
- Acute - this pathological form begins abruptly with a sudden increase in temperature, hematuria, lumbar pains and an increase in secreted urine. If the disease is characterized by a complex degree, then kidney failure may develop. The cause of the pathology are infections and allergic diathesis, protein injections and lymphoproliferative diseases.
According to the clinical picture, the pathology is classified into:
- Focal interstitial nephritis - when pathological signs are characterized by a weak character, the patient is troubled by polyuria, the patients are usually quickly cured;
- Severe form - when interstitial nephritis is accompanied by signs of prolonged absence of urine and kidney failure. The patient needs urgent hemodialysis, otherwise the risk of death increases;
- Deployed nephritis - when all manifestations have pronounced characteristics;
- Abortive form - the patient does not disturb anuric disorders, he quickly goes on to recover, the kidneys restore their activity. This type of interstitial nephritis is characterized by positive dynamics and is not dangerous for the patient.
There is another classification of this renal pathology - for etiological reasons:
- Idiopathic nephritis - when the cause of the disease can not be established;
- Autoimmune - the causes of the pathological process lie in immune failures;
- Postinfectious - the disease was previously promoted by the infection;
- Toxico-allergic interstitial nephritis - develops under the influence of long-term chemical, toxic, medicinal effects on the body.
On the video about the forms of interstitial nephritis:
Pathogenesis
The leading role in the formation of interstitial forms of nephritis is given to the antibody and immunocomplex mechanism. An antithetic mechanism of development is noted with organic intoxication with penicillins and a crisis caused by rejection of the graft. Immunocomplex mechanism of development is characteristic for red systemic lupus, prolonged therapy of NSAIDs and pathologies of lymphoproliferative nature. How does the disease develop?
During the pathological process in the kidney tissues, inflammatory puffiness, vascular spasm, leading to a sharp narrowing of the vessels and ischemia of the organ is formed. Intracanillular pressure rises, plasma current flows through the kidneys, the creatinine level increases. If the kidney ischemia is pronounced, then the risk of developing papillary necrosis, accompanied by an abundance of bloody impurities in the urine, is great.
Against the background of inflammation in the interstitial kidney tissues, cellular infiltration develops. All of the above processes lead to a long-term disruption of urine concentration and a persistent inflammatory process in the kidney tissues.
Symptoms and signs
The clinical picture of interstitial renal inflammation depends on the form of the pathological process. Acute nephritis usually occurs about the third day after the onset of pathologies of an infectious nature and the administration of diuretic, antibiotic agents.
Patients report:
- Lack of appetite;
- Sluggish and weakened state;
- Nausea and vomiting syndrome;
- Hyperthermia;
- Myalgic symptoms;
- Increased blood pressure;
- Allergic rashes on the skin surface;
- Kidney failure.
Patients develop glomerulosclerosis and chronic kidney failure. Glomerulosclerosis causes severe swelling and proteinuria.
Symptoms like:
- Allergic rashes;
- Wavy fever;
- Polyuria or anuria;
- Soreness in the lumbar region;
- Constant sensation of thirst and dry mouth;
- Anemia;
- Elevated pressure, etc.
In children, the first sign of a pathology is the onset of swelling and the development of polyuria. Analyzes show in the blood an elevated level of urea and creatinine. For patients of childhood, the most common acute pathological form, although there are cases of chronic nephritis, which is caused by improper treatment or lack of it.
Diagnostics
During the diagnosis of pathology, the patient is assigned a number of procedures, for example, biochemical and general urine and blood analysis, urine culture, Zimnitsky and Reberg assays, renal biopsy. In the presence of interstitial nephritis, an elevated level of urea and creatinine is detected in the blood, leukocytosis takes place. Urinalysis shows the presence in the urine of proteins, minor blood impurities and eosinophilic cells.
Zimnitsky's test allows to assess the concentration ability of the kidneys, and the Reberg sample shows the degree of excretory functionality and the ability of the renal tubules to secrete and suck in various substances. Urine culture allows to determine the presence of bacterial pathogens in it. In addition, ultrasound examination of the kidneys is prescribed.
Treatment of
The approach to the treatment of interstitial nephritis depends on its shape and etiology. Great importance is given to the dehydration of the patient, and if acute kidney failure occurs, emergency hemodialysis is necessary.
Acute
Acute nephritis often occurs when taking medications, so the first appointment is to cancel all medications that can cause pathology. If the effect of withdrawal of drugs is absent, then after 2 days hormone therapy with corticosteroids is prescribed. With the further increase in the clinic for kidney failure, Prednisolon is indicated, and with pronounced renal impairment, pulse therapy with Methylprednisolone is recommended.
Chronic
Chronic interstitial nephritis is treated with the use of drugs, whose action is aimed at improving renal microcirculation. Sometimes the therapy is supplemented with corticosteroid medications. A diet with a predominance of B-group vitamins, potato-cabbage or hypoallergenic diet and abundant drink is shown. If the blood pressure is normal, then the use of salt is not prohibited.
Forecasts and complications of
Among the most likely complications experts call:
- Development of persistent hypertension;
- Chronicity of acute interstitial nephritis;
- Formation of kidney failure acute or chronic.
For acute nephritis, the predictions are usually favorable. If the pathology has passed into a chronic form, then the treatment will be more complex and time-consuming. In the absence of therapeutic measures, the risk of a lethal outcome increases.
Prevention
Avoid this pathology by avoiding hypothermia and excessive physical overload, avoiding long-term use of medications. A day should drink at least 2 liters.water, and when infectious foci appear, it is necessary to carry out their sanation in a timely manner.