Tubulointerstitial nephritis: symptoms and treatment

Tubulointerstitial nephritis is an ailment of a group of primary non-specific kidney pathologies. The inflammatory process occurs in the renal tubules and interstitium, and then spreads to other tissue structures in the kidneys. The disease is characterized by an allergic, toxic or infectious genesis and worsens kidney function.



According to the ICD-10 of 1995, there are several forms of the disease depending on the extent of the lesion. The generality of pyelonephritis and interstitial nephritis is manifested in the similarity of the character of morphological pathologies and the type of tubular lesion. However, the different etiology, as well as the nature of pathogenesis, do not allow us to consider these two diseases as two forms of the same disease.

Causes of occurrence

The disease is accompanied by inflammation of the interstitial tissue of the kidney with subsequent infiltration of its lymphocytes (up to 80% of the number of cells), granulomas or leukocytes of a nuclear-polymorphic type. The epithelium of the tubules first swells, then in its cells there is a dystrophy, which is followed by necrosis. Inclusion of immunoglobulins during the research, as a rule, are not detected.

To date, the number of cases of nephritis caused by infections is decreasing, although acute tubulointerstitial nephritis very often begins to develop after human infectious ailments (up to 95% of cases). Other reasons for the appearance of the disease include:


  • pyelonephritis (bacterial kidney damage)
  • cancerous growths (leukemia, tumors)
  • diseases inherited;
  • intoxication with medicines, chemical compounds
  • Nephropathy in different forms
  • immune diseases

Symptoms

The course of the disease depends on its shape. The main symptoms of the ailment are:


  1. elevated body temperature;
  2. fever;
  3. urticaria rash (urticaria)
  4. pain during urination
  5. increase the size of both kidneys;
  6. detection of purulent discharge in the urine
  7. the presence of pain in the lumbar region and in the side
  8. general weakness;
  9. Decreased activity due to excessive fatigue
  10. loss of appetite.

Sometimes the symptoms for a long period of time are hidden or unobtrusive, which makes it possible to detect a malaise only in a medical examination that will show the presence of renal failure.

Chronic tubulointerstitial nephritis has a nonspecific symptomatology, so the patient for a long time does not pay attention to the signs of the development of pathology, or simply confuses them with the symptoms of other ailments. In some cases, the body may retain fluid. The acute form of the disease is characterized by thirst, the presence of frequent urination.

Tubulointerstitial nephritis occurs in children with a frequency of 1.5% to 5%, according to renal biopsy data. Specialists are inclined to believe that the etiology of the disease is immunoallergic. Quite often the disease begins to progress if the child has dysmetabolic nephropathy (approximately 15% of cases). To prevent the appearance of pathology, the child’s parents are required, when symptoms appear, to see a doctor, to treat immune, allergic and other diseases, and also the pathology of metabolism on time and to the end.

Forms of the disease

There are three main forms of ailment:


  • hereditary. Another name is Alport syndrome. This tubulointerstitial nephritis in children is inherited and is a non-immune glomerulopathy. Sometimes hematuria is manifested, kidney function is significantly reduced, which causes kidney failure. Often accompanied by problems with vision and deafness. When the disease glomerular membranes increase in size and begin to separate. The disease is caused by a mutation in a collagen gene of type 4, and its severity depends on the degree of gene expression. The incidence of the disease is 17 cases per 100,000 children
  • acute. Acute tubulointerstitial nephritis is an abacterial form of the inflammatory process in the kidney tissue. Also in the inflammatory process are involved tubules, blood vessels and lymph in the renal stroma. This toxic subspecies of the disease can occur at any age, including the newborn. It is considered the most severe form of the disease, which mainly arises from the reaction of the body to the administration of certain medications.

Drugs that can cause disease are penicillin, gentamicin, analgin, and various barbiturates and non-steroidal medications. In addition, the reaction in the body can arise due to the ingress of a large amount of lithium, gold, lead, mercury, as well as irradiation with radiation. In this case, it is important not so much the number of drugs that are in the body, but how long their reception lasted and what the sensitivity of the organism to them. After getting medication into the patient’s body, the kidneys develop an allergic type of edema. The acute form of nephritis is also observed in hepatitis, diphtheria, leptospirosis and various burns.


  1. Chronic. Chronic tubulointerstitial nephritis is a disease of the polytheological type. It is manifested through the abacterial inflammation of the interstitial renal tissue together with the tubules, lymphatic, and also blood vessels in the stroma of the kidneys. The disease develops as a result of metabolic disorders, transferred infections (hepatitis, tuberculosis), medication or vitamins. The chronic form of the disease in children is found more often than acute. The manifestation of signs of the disease is preceded by a long latent stage. This causes often accidental diagnosis of the disease (when taking urine tests after, for example, transferred diseases). Chronic form may occur due to hypoimmune condition, abnormalities in the development of the organs of the urinary system, or because of the dysembryogenesis of the tissue of the affected organ.

Diagnostics

For the diagnosis of the disease, as well as its subsequent treatment, the patient should consult a nephrologist. He will be able to make a preliminary diagnosis on the basis of:


  • patient history analysis
  • patient complaints of pain, trouble urinating, and other characteristic symptoms
  • Information obtained through physical research. In urine tests, a reduced amount of protein, white blood cells, and erythrocytes can be detected. In this case, urine has a lower density and contains sodium in a small amount;
  • tests from the laboratory
  • kidney ultrasound;
  • X-ray examination of the kidneys
  • magnetic resonance imaging (MRI)
  • kidney biopsy.

Treatment

The principles of treatment of a disease, such as tubulointerstitial nephritis, include:


  1. Elimination of the cause of pathology. If the patient has an acute form of the disease, the first stage of treatment is the detection and discontinuation of the medications that triggered an allergic reaction. But it is worth noting that this does not help to eliminate the already begun fibrosis of the kidneys, which in some cases is irreversible. Also, if the disease is caused by an allergy, the patient may be prescribed corticosteroids. They will help to speed up the healing process;
  2. the organization of the patient’s life regimen, which involves reducing the functional load on the kidney tissue;
  3. A diet that minimizes the burden on the kidneys
  4. elimination of metabolic disorders
  5. Renal function restoration
  6. elimination of sclerosis of renal tissue
  7. taking antibacterial, antifungal medicines, as well as uroseptics
  8. physiotherapy procedures.

To conduct detoxification in the body, the patient is given an infusion treatment. Drugs are prescribed based on the results of urine culture tests and antibiotic sensitivity indicators. In addition, the list of drugs includes the use of stimulants of immunity.




The success of treatment directly depends on the stage of the detected disease and whether the irreversible tissue fibrosis began as a result of the inflammatory process. Considering the fact that many genetic and other factors of the disease can not be corrected, the patient can develop a terminal stage of kidney failure.

Visible results of treatment are already observed within 2 months after its beginning, although the characteristic residual scars can form on the kidney tissues. The patient may not recover completely, having azotemia above the normative level. Changes in histology are often reversible if the doctor recognizes and corrects the cause of the onset in time. However, kidney failure, diffuse infiltration indicate an irreversible violation of the body. The prognosis for curing the chronic form of the disease depends on whether the doctor in time will detect and prevent the onset of fibrosis.

With regard to nutrition in case of illness, the food consumed should not be fatty, spicy, sour, fried. It is strictly forbidden to drink alcoholic beverages. It is recommended to include in the diet boiled, steamed vegetables and meat, as well as greens, fruits and dairy products. Also need to consume enough vitamins and minerals. To make the right individual diet, you need to contact your doctor.

Traditional medicine also has many recommendations for the cure of the disease, but it is worth remembering the accuracy of the use of folk remedies. Before starting any form of folk remedies, you need to consult a doctor. If he approves the use of the tool, you can start using it.

The most popular folk remedies include:


  • Medicinal herbal preparations. Mixtures of leaves of nettle, birch, parsley and other medicinal plants are used. They help alleviate the symptoms, get rid of toxins in the body. There are dozens of fees that apply to nephritis in both children and adults. In particular, according to some folk recipes, nephritis is treated with the help of tincture of bearberry. It is worth knowing that this herb is not used by pregnant women
  • The reception of berries. Widely used cowberry and strawberries. They are recommended to use in a ratio of 1: 1 with sugar. If you boil strawberry leaves, the decoction of them is also suitable for consumption in small quantities
  • Pumpkin reception. It is recommended that it be baked in the oven with sugar in a ratio of 1: 1 and consumed throughout the day;
  • The use of quince. In the decoction go both the seeds and leaves of the fruit, and the product itself is recommended to be used 4 times a day for a tablespoon

Prevention

Acute tubulointerstitial nephritis can be prevented by the following methods:


  1. control over the intake of medications. Do not self-medicate, take medicine in high doses, without consulting your doctor,
  2. rejection of bad habits that have a detrimental effect on kidney function (smoking, drinking alcohol)



  3. a healthy and balanced diet that contains all the necessary vitamins, minerals.