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Interstitial Nephritis in Children

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Pediatric Kidney Disease

Abstract

Tubulointerstitial nephritis (TIN) is an important cause of acute kidney injury. The two most common triggers are hypersensitivity reactions to drugs and infections. Accompanying extra-renal manifestations are present in a minority, emphasizing the need for a high index of suspicion to make an early diagnosis that maximizes the potential for full renal functional recovery. The epidemiology of drug-induced TIN indicates that proton pump inhibitors, antibiotics and non-steroidal anti-inflammatory medications are the leading offenders, though numerous drugs have been implicated. Medication cessation and early treatment with a short course of corticosteroids for severe biopsy-confirmed cases are recommended. Appropriate antimicrobial therapy improves TIN associated with numerous bacterial, viral, fungal and parasitic infections. TIN may also occur as a consequence of a systemic autoimmune disease, the most common in the pediatric age group being the tubulointerstitial nephritis with uveitis (TINU) syndrome. Rarer causes include Sjögren’s syndrome, sarcoidosis, ANCA+ vasculitis and systemic lupus erythematosus. Acute TIN appears to be idiopathic in approximately 10 % cases. Chronic TIN characterized by interstitial inflammation and fibrosis, tubular atrophy and irreversible renal functional impairment may be a sequel to acute TIN and it may be caused by a variety of inherited diseases including the ciliopathies, polycystic kidney disease, metabolic diseases and familial TIN due specific mutations in the UMOD, REN or FAN1 genes. Non-specific chronic TIN is a universal feature of all chronic kidney diseases, even when the primary kidney disease process is due to glomerular disease, vascular pathology or abnormal renal development.

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Authors and Affiliations

  1. Department of Pediatrics, Division of Nephrology, University of Minnesota Children’s Hospital, 2450 Riverside Avenue, MB 682, Minneapolis, MN, 55439, USA

    Priya S. Verghese

  2. Department of Pediatrics and Communicable Diseases, Division of Nephrology, C.S. Mott Children’s Hospital, University of Michigan Health System, 1540 East Hospital Drive, Ann Arbor, MI, 48109, USA

    Kera E. Luckritz

  3. Department of Pediatrics, University of British Columbia, 4480 Oak Street, 2D15, Vancouver, British Columbia, Canada

    Allison A. Eddy

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  1. Priya S. Verghese
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  2. Kera E. Luckritz
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  3. Allison A. Eddy
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Correspondence to Allison A. Eddy .

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Editors and Affiliations

  1. Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada

    Denis F. Geary

  2. Division of Pediatric Nephrology, University of Heidelberg, Heidelberg, Germany

    Franz Schaefer

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Verghese, P.S., Luckritz, K.E., Eddy, A.A. (2016). Interstitial Nephritis in Children. In: Geary, D., Schaefer, F. (eds) Pediatric Kidney Disease. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-52972-0_38

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