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Tubulointerstitial Nephritis in Children

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Pediatric Kidney Disease

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Abstract

Tubulointerstitial nephritis (TIN) is an important cause of acute kidney injury. The two most common causes in the pediatric age group are immune-mediated reactions to drugs and infections and the syndrome of tubulointerstitial nephritis and uveitis (TINU). Clinical features of TIN are heterogenous and not pathognomonic, emphasizing the need for a high index of suspicion to make an early diagnosis that maximizes the potential for full renal recovery. The epidemiology of drug-induced TIN indicates that proton pump inhibitors (PPIs), antibiotics and non-steroidal anti-inflammatory medications are the leading offenders, though numerous drugs have been implicated. Medication cessation and early treatment with a short course of corticosteroids for severe biopsy-confirmed cases are recommended for cases that do not improve with withdrawal of the offending agent. Appropriate antimicrobial therapy has improved TIN associated with infections, although it does still occur, particularly in immunocompromised transplant recipients. In addition to TINU, TIN may also be one of the manifestations of other autoimmune systemic diseases such as sarcoidosis, Sjögren’s syndrome, anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis and systemic lupus erythematosus. The cause of TIN is unknown in approximately 8% of cases. Chronic TIN, characterized by interstitial inflammation and fibrosis, tubular atrophy and irreversible renal functional impairment may be a sequelae to acute TIN or it may be caused by a variety of inherited diseases, including the ciliopathies, polycystic kidney disease, metabolic diseases and autosomal dominant tubulointerstitial kidney disease (ADTKD). Non-specific chronic TIN is a universal feature of all chronic kidney diseases, even when the primary kidney disease is a glomerular disease, vascular pathology or abnormal renal development.

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  1. Priya S. Verghese, Kera E. Luckritz and Allison A. Eddy contributed equally with all other contributors.

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  1. Ann & Robert H. Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Priya S. Verghese

  2. C.S. Mott Children’s Hospital, University of Michigan Health System, Ann Arbor, MI, USA

    Kera E. Luckritz

  3. Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada

    Allison A. Eddy

  4. BC Children’s Hospital, Vancouver, BC, Canada

    Allison A. Eddy

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  1. Division of Pediatric Nephrology, Heidelberg University, Heidelberg, Germany

    Franz Schaefer

  2. Emory School of Medicine, Emory University, Atlanta, GA, USA

    Larry A. Greenbaum

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Verghese, P.S., Luckritz, K.E., Eddy, A.A. (2023). Tubulointerstitial Nephritis in Children. In: Schaefer, F., Greenbaum, L.A. (eds) Pediatric Kidney Disease. Springer, Cham. https://doi.org/10.1007/978-3-031-11665-0_42

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-11664-3

  • Online ISBN: 978-3-031-11665-0

  • eBook Packages: MedicineMedicine (R0)

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