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      Tubulointerstitial Nephritis: Diagnosis, Treatment and Monitoring

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          Abstract

          Tubulointerstitial nephritis (TIN) is a frequent cause of acute kidney injury (AKI) that can lead to chronic kidney disease (CKD). TIN is associated with an immune-mediated infiltration of the kidney interstitium by inflammatory cells, which may progress to fibrosis. Patients often present with non-specific symptoms, which can lead to delayed diagnosis and treatment of the disease. Etiology of TIN can be drug-induced, infectious, idiopathic, genetic, or related to a systemic inflammatory condition such as tubulointerstitial nephritis and uveitis (TINU) syndrome, inflammatory bowel disease, or IgG4-associated immune complex multiorgan autoimmune disease (MAD). It is imperative to have a high clinical suspicion for TIN in order to remove potential offending agents and treat any associated systemic diseases. Treatment is ultimately dependent on underlying etiology. While there are no randomized controlled clinical trials to assess treatment choice and efficacy in TIN, corticosteroids have been a mainstay of therapy and recent studies have suggested a possible role for mycophenolate mofetil. Urinary biomarkers such as alpha1-microglobulin and beta2-microglobulin may help diagnose and monitor disease activity in TIN. Screening for TIN should be implemented in children with inflammatory bowel disease, uveitis, or IgG4-associated MAD.

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          Author and article information

          Journal
          8708728
          1785
          Pediatr Nephrol
          Pediatr. Nephrol.
          Pediatric nephrology (Berlin, Germany)
          0931-041X
          1432-198X
          11 June 2016
          07 May 2016
          April 2017
          01 April 2018
          : 32
          : 4
          : 577-587
          Affiliations
          [1 ] Division of Nephrology, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15224, USA
          [2 ] Department of Anaesthesiology and Intensive Therapy, Medical University of Gdansk and Department of Ophthalmology, Medical University of Gdansk, 80-299, Gdańsk, Poland
          [3 ] Department of Pediatric Pathology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA
          Author notes
          Corresponding Author: Dr. Emily Joyce, 4401 Penn Avenue, Pittsburgh, PA 15224, Phone (412) 692-5182, Fax (412) 692-7443, Emily.Joyce@ 123456chp.edu
          Article
          PMC5099107 PMC5099107 5099107 nihpa792763
          10.1007/s00467-016-3394-5
          5099107
          27155873
          5a738d13-4daa-43cb-8f5d-9519b7cfdf1b
          History
          Categories
          Article

          Monitoring,Treatment,Inflammatory Bowel Disease,TINU Syndrome,Chronic Kidney Disease,Acute Kidney Injury,Tubulointerstitial Nephritis

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