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Key Features

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  • Characterized by diffuse or focal inflammation and edema of the renal interstitium and secondary involvement of the tubules

  • Most commonly drug related (eg, β-lactam–containing antibiotics or nonsteroidal anti-inflammatory drugs), but infectious etiologies, including Epstein-Barr virus, also occur

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Clinical Findings

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  • Fever, rash, and eosinophilia may occur in drug-associated cases

  • Association between tubulointerstitial nephritis and uveitis is occasionally seen in childhood

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Diagnosis

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  • Urinalysis usually reveals leukocyturia and mild hematuria and proteinuria

  • Hansel staining of the urinary sediment often demonstrates eosinophils

  • The inflammation can cause significant deterioration of renal function and systemic hypertension

  • Renal biopsy may be performed to demonstrate the characteristic tubular and interstitial inflammation

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Treatment

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  • Immediate identification and removal of the causative agent whenever possible is imperative and may be all that is necessary

  • Corticosteroids are helpful in patients with progressive kidney disease or associated nephrotic syndrome

  • Dialysis support is occasionally required

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