0521779407-20 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:22
1468 Tubulointerstitial Renal Disease■Acute vs. Chronic TIN or other cause of ARF?
■Is patient non-oliguric, oliguric or anuric?
■assess volume status (pre-renal, euvolemic, volume overloaded)
■Is a life-threatening electrolyte, acid-base abnormality present?
■Call Nephrology Consult
General Measures
■avoid nephrotoxic drugs (NSAIDs and ACEI)
■remove or treat causative factors
➣Review present, recent and past drug use
➣Evaluate for infection – treat
➣Evaluate for systemic disease – treat
■Obtain ultrasound
➣check kidney size
➣echo density
➣rule out obstruction
specific therapy
Depends on Cause:
■Drug induced-stop drug
■Infectious – treat infection
■Systemic disease – treat-underlying disease (Sarcoidosis, Sjogren’s,
SLE-treat with steroids)
■Idiopathic (TINU and true idiopathic cause -consider steroids)
➣if after stop drug BUN/Cr do not increase further, monitor con-
servatively.
➣keep patient euvolemic
➣adjust drug doses for decreased GFR
➣avoid nephrotoxins (NSAIDs and ACEI)
Acute TIN
■early treatment is essential
■acute TIN treated within the first 2 weeks, the post recovery serum
Cr approx 1 mg/dl
■Cr for those treated after 3 weeks of acute TIN >3.0 mg/dl
■longer time between diagnosis and treatment, the worse the recovery
creatinine
■late treatment after extensive fibrosis on biopsy less beneficial
■if renal function not improving after 2–3 days, proceed to biopsy
■with biopsy confirmation or strong history to suggest acute
TIN (drug, some systemic diseases and idiopathic) – prednisone
1 mg/kg/day