Internal Medicine

0521779407-20 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:22

Tubulointerstitial Renal Disease 1469

■steroids shorten time to recovery-best if started early

■if no response to steroids after 2 weeks consider cyclophospham-

ide

■Discontinue steroids if no response after 3–4 weeks

■stop cyclophosphamide if no response after 4–6 weeks

■if anti TBM found on biopsy treat with steroids, cyclophosphamide

and also consider 2-week trial of plasmapheresis

■initiate dialysis early if oliguric, uremic, volume overloaded.

Chronic TIN

■investigate cause and treat

■stop offending drugs (lithium NSAIDs),

■treat systemic disease

■relieve obstruction

■aggressive BP control

■biopsy not always indicated

■extent and severity of fibrosis on biopsy will predict GFR and prog-

nosis

follow-up

Acute TIN

■daily monitor of BUN/Cr, acid/base and electrolytes

■daily assess volume status, urine output, need for dialysis

Chronic TIN

■periodic charting of BUN/Cr

■periodic calculation of GFR refer to Nephrology when serum creati-

nine is sustained >1.5 mg/dl

complications and prognosis

Acute TIN

■post recovery serum creatinine if treatment started before 2 weeks,

approx 1 mg/dl

■post recovery serum creatinine if treatment delayed after 3 weeks,

approx 3 mg/dl

Chronic TIN

■may lead to chronic renal impairment and progression to ESRD with-

out and even with aggressive management