Nephritis- urinary system disease

7/30/2019 Nephritis- urinary system disease

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NEPHRITISTubulointerstitial

Nephritis (TIN)

Ms. Harpreet Kaur

Lecturer


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DEFINITION

Nephritis suggests a noninfectious inflammatory

process that involves the nephron .

Term nephritis is also applied to a group of unrelated

inflammatory disorders known collectivelyas tubulointerstitial nephritis (TIN) . TIN initially

affects mainly the interstitium and renal tubules

Nephritis is term used to clinically denote a child

with hypertension, decreased renal function,

hematuria, and edema.


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ETIOLOGY

Antigen-antibody complexes trapped in the renal

parenchyma : process of inflammation and cell

proliferation, in which endothelial or epithelial cells

are stimulated to proliferate in varying degrees, isinitiated, which damages normal renal tissue

An infection, a drug, a metabolic abnormality


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EPIDEMIOLOGY

TIN is very rare in children younger than age 5

years. Acute TIN can potentially occur in

people of any age. Chronic TIN tends to occur

late in childhood or adolescence


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CLINICAL MANIFESTATIONS

Allergic manifestations, most have fever

Nonspecific symptoms, such as malaise, fever,

anorexia, or weakness, may be present

Facial swelling and perioral, or pedal edema orascites

Symptoms of pulmonary edema or congestive heart

failure (eg, dyspnea with exertion, orthopnea,shortness of breath) may be present


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CLINICAL MANIFESTATIONS

Gross hematuria (eg, dark, rust colored, coke

colored, tea colored) may be present.

With severe hypertension, identify nosebleed,

headache, or encephalopathy.


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DIAGNOSTIC EVALUATION

PHYSICAL EXAMINATION

Elevated blood pressure is an important physical

finding

Look for edema

The child may have a pale appearance

Tachypnea, dyspnea, hepatic congestion, and gallop

rhythm suggest fluid overload with congestive heartfailure


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DIAGNOSTIC EVALUATION CONTD..

With tubulointerstitial nephritis (TIN), physicalfindings include maculopapular rash, joint pain(with flexion and extension), and fever

LABORATORY STUDIES

Electrolyte, creatinine, and blood urea nitrogen(BUN) levels

Complete blood count (CBC)

Urinalysis

Urine culture


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DIAGNOSTIC EVALUATION CONTD..

Lupus serologies Measurement of complement components (ie, C3,

C4)

Antistreptolysin-O (ASO) titer

Anti-DNAase B

Perinuclear antineutrophil cytoplasmic antibody (P-

ANCA) measurement

Cellular antineutrophil cytoplasmic antibody (C-

ANCA) assessment


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DIAGANOSTIC EVALUATION CONTD..

Serum IgA measurement

Laboratory findings in tubulointerstitial

nephritis (TIN) include hematuria,

eosinophilia, sterile pyuria, low-grade

proteinuria, eosinophiluria, and urinary white

blood cell casts


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DIAGANOSTIC EVALUATION CONTD..

IMAGING STUDIES

Renal ultrasonography is usually performed to

exclude other causes of hypertension and hematuria,

such as renal artery stenosis (ie, small, abnormalkidney on one side)

No imaging tests are sensitive or specific for TIN.

Renal ultrasonography may show large kidney


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TREATMENT

INPATIENT CARE

Inpatient care is usually necessary only to manage

severe hypertension or complications of acute or

chronic renal failure (eg, dialysis access, uremicsyndrome, congestive heart failure, electrolyte

abnormalities such as hyperkalemia and pericardial

effusion)


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TREATMENT

OUTPATIENT CARE

Involve the use of antihypertensive, diuretics,

and diet modification

Outpatient therapy may involve dialysis in a

child who develops end-stage renal disease


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TREATMENT

DIET AND ACTIVITY

Fluid restriction may prevent fluid overload

Fluid restriction of 300 mL/m2/d plus losses may allow

In patients with hypertension, sodium restriction to therecommended daily allowance (RDA) of 2-4 mEq/kg/d may aid

in management In children with renal failure, potassium restriction is justified

to prevent hyperkalemia

A short-term high-carbohydrate diet may prevent catabolism

of body protein as an energy source Calcium supplementation is useful to maintain normal serum

calcium


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MEDICAL MANAGEMENT

ACE Inhibitors

Captopril, a competitive ACE inhibitor, prevents theconversion of angiotensin I to angiotensin II, a potentvasoconstrictor, increasing levels of plasma renin andreducing aldosterone secretion

A competitive ACE inhibitor, enalapril reducesangiotensin II levels, decreasing aldosterone

secretion. The drug lowers systemic arterial bloodpressure, reducing injury caused by elevated bloodpressure


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MEDICAL MANAGEMENT

Angiotensin II Receptor Antagonists

Losartan is a prototype ARB. It is specific for the type 1, as

opposed to type 2, angiotensin receptor. It may induce more

complete inhibition of the renin-angiotensin system than do

ACE inhibitors

Valsartan is a prodrug that directly antagonizes angiotensin II

receptors. It displaces angiotensin II from the AT1 receptor

and may lower blood pressure by antagonizing AT1-induced

vasoconstriction, aldosterone release, catecholamine release,arginine vasopressin release, water intake, and hypertrophic

responses


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MEDICAL MANAGEMENT

Calcium Channel Blockers

Calcium channel blockers, nifedipine causes peripheral arterial

vasodilation by inhibiting calcium influx across vascular

smooth-muscle cell membranes

Beta Adrenergic Blockers

Labetalol blocks alpha-1 beta 1-, and beta 2-adrenergic

receptor sites, decreasing BP

Propranolol has membrane-stabilizing activity and decreases

automaticity of contractions. Propranolol is not suitable for

emergency treatment of hypertension. Do not administer IV

in hypertensive emergencies

Nephritis- urinary system disease

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