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Acute Interstitial Nephritis Due to Drugs: Review of the Literature with a Report of Nine Cases

ADAM L. LINTON, M.B.; WILLIAM F. CLARK, M.D.; ALBERT A. DRIEDGER, M.D.; D. IAN TURNBULL, M.D.; and ROBERT M. LINDSAY, M.D.
[+] Article and Author Information

▸Requests for reprints should be addressed to Adam L. Linton, M.B.; Department of Medicine, Victoria Hospital, South Street Campus; London, Ontario, Canada N6A 4G5.


London, Ontario, Canada


© 1980 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1980;93(5):735-741. doi:10.7326/0003-4819-93-5-735
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Acute interstitial nephritis due to drugs commonly presents as acute renal failure and may be commoner than is presently realized. Drugs implicated include not only methicillin and other penicillins but also diuretics and nonsteroidal anti-inflammatory agents. The mechanism of injury likely involves an immunologic disturbance, possibly a delayed hypersensitivity reaction. Differential diagnosis from other causes of acute renal failure may be difficult, but coincident evidence of an acute allergic reaction may help, as may the detection of eosinophils in the urine or avid uptake of 67Ga by the kidneys. Definitive diagnosis may require renal biopsy, which will reveal normal glomeruli and a patchy but usually heavy interstitial infiltrate with lymphocytes, plasma cells, and eosinophils. Diagnosis of acute interstitial nephritis is important, because withdrawal of the offending agent will usually result in rapid improvement in renal function, and steroid therapy may reduce residual chronic renal damage.

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