0521779407-20 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:22
Tubulointerstitial Renal Disease 1465■Drug Induced
➣most common cause of acute TIN
➣occurs 2–60 days after beginning drug
➣not dose related
➣cannot be ruled out by prior exposure without adverse reaction
➣recurs with exposure to the same or similar drugs
➣may be accompanied by systemic manifestation of hypersensi-
tivity, rash (50% of cases) fever (75% of cases), eosinophilia (40%-
80% of cases)
■Drugs Implicated include:
➣Antibiotics:
ampicillin, penicillin, methicillin and congeners, cephalo-
sporins, ciprofloxacin, rifampin, sulfonamides, ethambutol,
polymixin, trimethoprim/sulfamethoxazole, and many others
➣Anticonvulsants:
phenytoin, carbamazepine, phenobarbital
➣Diuretics:
furosemide, metolazone, thiazides, triamterene
➣NSAIDs: see chapter on analgesic nephropathy
➣Miscellaneous:
Allopurinol, azathioprine, captopril, cimetadine, clofibrate,
cyclosporine, gold, interferon, lithium, warfarin, herbal prepa-
rations
➣List of implicated drugs continues to expand; however biopsy
confirmation often lacking
■Systemic Disease
➣Anti-tubular basement membrane mediated
➣Sjogren’s syndrome
➣Sarcoidosis (hypercalcemia, hypercalciuria granulomatous dis-
ease)
➣Systemic lupus erythematosus
➣Cryoglobulinemia
■Infection
➣Direct Involvement of renal parenchyma
classic cause is bacterial pyelonephritis
may also be fungal, viral, parasitic
➣Systemic Infection
occurs with or without infectious agent identified in renal
interstitium
Bacteria – beta streptococci, Legionella, Brucella, Mycopla-
sma, Treponema