Idiopathic acute tubulointerstitial nephritis

Introduction to idiopathic acute tubulointerstitial nephritis Idiopathicacutetubulointerstitial nephritis (ATIN) is a small interstitial disease of unknown etiology caused by non-drug, non-infectious, non-systemic diseases. There is a group of idiopathic tubulointerstitial nephritis. The disease has been mediated by immune mechanisms, known as idiopathic immune-mediated tubulointerstitial nephritis, which is mediated by antibodies or T cells, and can be characterized by idiopathic immune-mediated tubules. Qualitative nephritis is divided into idiopathic T cell-mediated tubulointerstitial nephritis and idiopathic antibody-mediated tubulointerstitial nephritis. basic knowledge The proportion of sickness: 0.01% Susceptible people: no specific population Mode of infection: non-infectious Complications: anemia

Idiopathic acute tubulointerstitial nephritis

(1) Causes of the disease

The cause is unknown, the disease may be caused by some unknown injury factors, a report that the "kidney-eye syndrome" with uveitis may be related to chlamydial infection.

(two) pathogenesis

The pathogenesis of idiopathic ATIN is unclear and may be associated with anti-tubular basement membrane antibodies, elevated blood eosinophilia and elevated serum IgE levels, or even glomerular lesions including membranous lesions, some with kidney, bone marrow and grapes Membrane granuloma infiltration, suggesting that the disease may be a systemic disease, the interstitial infiltration of mononuclear cells, the persistence of symptoms and the characteristics of self-initiated disease suggest that the pathogenesis of this disease may have an immunological basis.

Recently, an anti-neutrophil cytoplasmic antibody (ANCA) was detected in a 5-year-old female and a 37-year-old male tubulointerstitial nephritis-uvitis syndrome, which is a perinuclear type, suggesting that autoimmunity may be involved in some cases. The pathogenesis of this disease, almost all kinds of interstitial nephritis have lymphocytic infiltration, but in addition to transplant rejection, other diseases are generally not confirmed by these lymphocytes, but strong morphological and immunological evidence support T cells mediate the pathogenesis of three allergic nephritis, such as drug allergy, sarcoma-like disease and idiopathic acute tubulointerstitial nephritis, uveitis syndrome. These diseases are called idiopathic T cells. Mediated tubulointerstitial nephritis.

It has been recognized that there are two types of antibody-mediated tubulointerstitial nephritis: one is mediated by antibodies against the basement membrane of the tubule, called the anti-tubular basement membrane disease; the other is mediated by antibodies against other unknown antigens, Circulating or in situ formation of immune complex deposits, these two types of tubulointerstitial nephritis may appear as primary lesions or as secondary manifestations in other kidney diseases.

Idiopathic acute tubulointerstitial nephritis prevention

The cause of this disease is unknown, there is no effective preventive measures, but if you pay attention to reasonable diet, actively strengthen physical activity, and constantly improve the body's disease resistance, it can effectively prevent the occurrence of diseases.

Idiopathic acute tubulointerstitial nephritis complications Complications anemia

1. Ocular uveitis.

2. Anemia and bone marrow granuloma, chronic renal insufficiency.

Idiopathic acute tubulointerstitial nephritis symptoms common symptoms leukocyte urinary kidney damage nausea blood urinary protein protein fatigue ESR increased weight loss

The clinical manifestations of this disease are acute tubulointerstitial nephritis. Unlike drug-induced ATIN, idiopathic ATIN is not often accompanied by rash, blood eosinophilia, this disease is associated with fatigue, anorexia, nausea, myalgia, Weight loss, mild to moderate anemia, increased erythrocyte sedimentation rate, urine test can be found hematuria, white blood cell urine, 24h urine protein below 1.5g, serum creatinine and urea nitrogen levels increased, special ATIN with anti-TBM antibodies can occur Particularly serious kidney damage.

In patients with tubulointerstitial nephropathy-uveitis syndrome, fever is also common. In addition to persistent renal and tubular dysfunction, bone marrow and lymphogranuloma, uveitis occurs at some point in the course of the disease. Bone marrow granuloma occurs.

Examination of idiopathic acute tubulointerstitial nephritis

1. Idiopathic acute interstitial nephritis, elevated levels of IgG, IgE, IgM, elevated eosinophils, increased serum creatinine and urea nitrogen levels, anti-TBM antibodies (special ATIN with anti-TBM antibodies) Particularly serious damage can occur), patients often have mild anemia, C-reactive protein positive, hypergammaglobulinemia and increased erythrocyte sedimentation rate.

2. Urine examination can be found in hematuria, proteinuria and leukocyteuria, 24h urine protein below 1.5g.

Renal biopsy pathological examination showed interstitial infiltrating lymphocytes, plasma cells, eosinophils, mesangial immunoglobulin precipitation, and tubular granule IgE and C3 precipitation.

Diagnosis and diagnosis of idiopathic acute tubulointerstitial nephritis

diagnosis

According to clinical manifestations, laboratory tests, renal biopsy pathological examination can diagnose the disease, the main clinical manifestations of this disease is acute tubulointerstitial nephritis, but not often accompanied by rash, blood eosinophilia, often obvious fatigue, anorexia , nausea, myalgia, weight loss, mild or moderate anemia, increased erythrocyte sedimentation rate, urine test can be found with hematuria, white blood cell urine, 24h urine protein below 1.5g, serum creatinine and urea nitrogen levels increased, anti-TBM antibody Special hair loss ATIN can cause particularly serious kidney damage.

In patients with tubulointerstitial nephropathy-uveitis syndrome, fever is also common. In addition to persistent renal and tubular dysfunction, bone marrow and lymphogranuloma, uveitis occurs at some point in the course of the disease. Bone marrow granuloma occurred, renal biopsy pathological examination showed interstitial infiltrating lymphocytes, plasma cells, eosinophils, mesangial immunoglobulin precipitation, tubule granular IgE and C3 precipitation, according to the above characteristics can be diagnosed.

Differential diagnosis

1. Identification of ATIN caused by drugs

The disease is not often accompanied by a rash, blood eosinophilia, often fatigue, anorexia, nausea, myalgia, weight loss, mild to moderate anemia, increased erythrocyte sedimentation rate, urine test can be found with hematuria, white blood cells Urine, 24h urine protein is below 1.5g, serum creatinine and urea nitrogen levels are increased, and special ATIN conjugates with anti-TBM antibodies can cause particularly serious damage.

2. Identification of ATIN caused by other causes

The disease is characterized by uveitis and fever in patients with tubulointerstitial nephritis-uvitis syndrome. Clinical manifestations include persistent renal function and tubule dysfunction, lymphogranuloma, and some cases. Bone marrow granuloma occurs.

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