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Allergic_Interstitial_Nephritis

Etiology: • Hypersensitivity type IV reaction. • Hypersensitivity reaction to penicillin, rifampin, nonsterioidal anti-inflammatory drugs, and sulfonamides account for most of the cases. • Many other drugs are capable of inducing interstitial nephritis (the list is long).

Pathogenesis: • Cell mediated immune reaction.

Epidemiology: • See etiology.

General Gross Description: • The kidneys are bilaterally enlarged, pale and somewhat soft compared to normal. • On cut section the corticomedullary junction may be indistinct.

General Microscopic Description: • The interstitium is widened by a diffuse inflammatory infiltrate consisting predominantly of lymphocytes. • Plasma cells, scattered eosinophils and some neutrophils are also usually present. • The interstitium would also show edema. • The tubules would be of normal caliber and not atrophic. • The glomeruli and arterial vasculature would appear normal.

Clinical Correlations: • The patients present with acute renal failure. • Urine sediment would show white cells, white cell casts, and occasionally eosinophils. • Mild proteinuria is present but not of nephrotic range. • Systemic manifestations of a hypersensitivity reaction such as rash, fever and arthralgias may be present.

References: Robbins Pathologic Basis of Disease, 5th Edition, (Cotran, Kumar, Robbins editors) pp. 972-973. •Primer on Kidney Disease, Greenberg A (editor), 1994, National Kidney Foundation, pp.153-157.