Skip to main content

Advertisement

SpringerLink
Log in

Interstitielle Nephritis bei rheumatischen Erkrankungen

Interstitial nephritis in rheumatic diseases

  • Leitthema
  • Published:
Zeitschrift für Rheumatologie Aims and scope Submit manuscript

Zusammenfassung

Interstitielle Nephritiden sind in Deutschland in etwa 12 % Ursache für eine terminale, dialysepflichtige Niereninsuffiizienz. Man versteht hierunter eine ätiologisch heterogene entzündliche Nierenerkrankung, die v. a. das Interstitium und die Tubuli betrifft. Medikamente, allen voran Antibiotika, nicht-steroidale Antiphlogistika und Protonenpumpenhemmer sind die häufigsten Auslöser. Rheumatologische Erkrankungen betreffen regelhaft auch die Nieren, entweder durch glomeruläre, aber auch durch interstitielle Prozesse. Diese können mit differenzierten Funktionsstörungen der Tubuli einhergehen. Der vorliegende Beitrag gibt eine Übersicht über die klinischen und laborchemischen Befunde bei interstitieller Nephritis im Kontext rheumatologischer Erkrankungen. Insbesondere tritt eine interstitielle Nephritis bei der Sarkoidose, dem TINU-Syndrom (tubulointerstitielle Nephritis mit Uveitis), dem primären Sjögren-Syndrom und der IgG4-assoziierten Erkrankung auf. Seltener sind andere Erkrankungen wie der systemische Lupus erythematodes, die systemische Sklerose, das DRESS-Syndrom („drug reaction with eosinophilia and systemic symptoms“) und die Granulomatose mit Polyangiitis Ursache dieser Veränderungen. Glukokortikoide sind die am häufigsten verwendeten Medikamente und sind oft die Basis der Therapie, bei refraktären Fällen oder unerwünschten Arzneimittelwirkungen kommen auch Second-line-Immunsuppressiva wie Mycophenolatmofetil, Azathioprin und andere, seltener Biologika zum Einsatz.

Abstract

Interstitial nephritis is responsible for about 12 % of end-stage renal disease in Germany. It comprises an etiologically heterogenous group of inflammatory renal disorders which primarily affect the renal interstitium and tubuli. Drugs, predominantly antibiotics, nonsteroidal anti-inflammatory drugs and proton pump inhibitors are causative in the majority of cases. Rheumatic diseases frequently affect the kidneys, either the glomeruli or the interstitial tissues. Inflammatory interstitial processes can be accompanied by complex functional tubular disorders. This review gives an overview about clinical and laboratory findings of interstitial nephritis in the context of rheumatic diseases. Sarcoidosis, tubulointerstitial nephritis and uveitis (TINU) syndrome, primary Sjogren’s syndrome, and IgG4-related disease often show an interstitial nephritis when the kidneys are affected. Other diseases, such as systemic lupus erythematosus, systemic sclerosis, drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, and granulomatosis with polyangiitis are more rarely associated with predominant interstitial nephritis. Glucocorticoids are the mainstay of therapy for most cases; in refractory cases or when side effects occur, second-line immunosuppressants such as mycophenolate mofetil, azathioprine and others, rarely biologics, can be used.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3

Literatur

  1. Alsuwaida AO (2013) Interstitial inflammation and long-term renal outcomes in lupus nephritis. Lupus 22:1446–1454. doi:10.1177/0961203313507986

    Article  CAS  PubMed  Google Scholar 

  2. Baker RJ, Pusey CD (2004) The changing profile of acute tubulointerstitial nephritis. Nephrol Dial Transplant 19:8–11

    Article  PubMed  Google Scholar 

  3. Bergner R, Hoffmann M, Waldherr R, Uppenkamp M (2003) Frequency of kidney disease in chronic sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 20:126–132

    PubMed  Google Scholar 

  4. Blank M-L, Parkin L, Paul C, Herbison P (2014) A nationwide nested case-control study indicates an increased risk of acute interstitial nephritis with proton pump inhibitor use. Kidney Int 86:837–844. doi:10.1038/ki.2014.74

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  5. Both T, Zietse R, Hoorn EJ et al (2014) Everything you need to know about distal renal tubular acidosis in autoimmune disease. Rheumatol Int 34:1037–1045. doi:10.1007/s00296-014-2993-3

    PubMed Central  CAS  PubMed  Google Scholar 

  6. Cacoub P, Musette P, Descamps V et al (2011) The DRESS syndrome: a literature review. Am J Med 124:588–597. doi:10.1016/j.amjmed.2011.01.017

    Article  CAS  PubMed  Google Scholar 

  7. Cervera R, Khamashta MA, Font J et al (2003) Morbidity and mortality in systemic lupus erythematosus during a 10-year period: a comparison of early and late manifestations in a cohort of 1,000 patients. Medicine (Baltimore) 82:299–308. doi:10.1097/01.md.0000091181.93122.55

  8. Chen Y-C, Chang C-Y, Cho Y-T et al (2013) Long-term sequelae of drug reaction with eosinophilia and systemic symptoms: a retrospective cohort study from Taiwan. J Am Acad Dermatol 68:459–465. doi:10.1016/j.jaad.2012.08.009

    Article  PubMed  Google Scholar 

  9. Colvin RB, Traum AZ, Taheri D et al (2014) Granulomatous interstitial nephritis as a manifestation of Crohn disease. Arch Pathol Lab Med 138:125–127. doi:10.5858/arpa.2012-0224-CR

    Article  PubMed  Google Scholar 

  10. Councilman WT (1898) Acute interstitial nephritis. J Exp Med 3:393–420. doi:10.1084/jem.3.4-5.393

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  11. Deshpande V, Zen Y, Chan JK et al (2012) Consensus statement on the pathology of IgG4-related disease. Mod Pathol Off J U S Can Acad Pathol Inc 25:1181–1192. doi:10.1038/modpathol.2012.72

    Google Scholar 

  12. Frei U, Schober-Halstenberg H-J (2008) Nierenersatztherapie in Deutschland – Bericht über Nierentransplantation und Dialysebehandlung in Deutschland 2006–2007. QuaSi Niere gGmbH, Berlin

  13. Gerke AK (2014) Morbidity and mortality in sarcoidosis. Curr Opin Pulm Med 20:472–478. doi:10.1097/MCP.0000000000000080

    Article  PubMed  Google Scholar 

  14. Goicoechea M, Rivera F, López-Gómez JM, Spanish Registry of Glomerulonephritis (2013) Increased prevalence of acute tubulointerstitial nephritis. Nephrol Dial Transplant 28:112–115. doi:10.1093/ndt/gfs143

    Article  PubMed  Google Scholar 

  15. González E, Gutiérrez E, Galeano C et al (2008) Early steroid treatment improves the recovery of renal function in patients with drug-induced acute interstitial nephritis. Kidney Int 73:940–946. doi:10.1038/sj.ki.5002776

    Article  PubMed  Google Scholar 

  16. Gorospe EC, Leggett CL (2012) Mesalazine-induced interstitial nephritis in a patient with ulcerative colitis. Case Rep 2012:bcr1220115351–bcr1220115351. doi:10.1136/bcr.12.2011.5351

    Google Scholar 

  17. Goules AV, Tatouli IP, Moutsopoulos HM, Tzioufas AG (2013) Clinically significant renal involvement in primary Sjögren’s syndrome: clinical presentation and outcome. Arthritis Rheum 65:2945–2953. doi:10.1002/art.38100

    Article  PubMed  Google Scholar 

  18. Gröne EF, Gröne H-J (2013) Renaler Lupus erythematodes: Histopathologische Diagnose und Differenzialdiagnose. Nephrol 8:474–482. doi:10.1007/s11560-012-0724-x

    Article  Google Scholar 

  19. Halbritter J, Mayer C, Rasche FM et al (2009) Interstitial nephritis. Internist (Berl) 50:1111–1125. doi:10.1007/s00108-009-2463-2

  20. Haydar AA, Hujairi N, Kirkham B et al (2004) Chronic overdose of leflunomide inducing interstitial nephritis. Nephrol Dial Transplant 19:1334–1335. doi:10.1093/ndt/gfh070

    Article  PubMed  Google Scholar 

  21. Hilderson I, Van Laecke S, Wauters A, Donck J (2014) Treatment of renal sarcoidosis: is there a guideline? Overview of the different treatment options. Nephrol Dial Transplant 29:1841–1847. doi:10.1093/ndt/gft442

    Article  PubMed  Google Scholar 

  22. Kamisawa T, Zen Y, Pillai S, Stone JH (2014) IgG4-related disease. Lancet. doi:10.1016/S0140-6736(14)60720-0

  23. Kawano M, Saeki T (2015) IgG4-related kidney disease – an update. Curr Opin Nephrol Hypertens 24:193–201. doi:10.1097/MNH.0000000000000102

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  24. Kodner CM, Kudrimoti A (2003) Diagnosis and management of acute interstitial nephritis. Am Fam Physician 67:2527–2534

    PubMed  Google Scholar 

  25. Korsten P, Mirsaeidi M, Sweiss NJ (2013) Nonsteroidal therapy of sarcoidosis. Curr Opin Pulm Med 19:516–523. doi:10.1097/MCP.0b013e3283642ad0

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  26. Korsten P, Sweiss NJ, Nagorsnik U et al (2010) Drug-induced granulomatous interstitial nephritis in a patient with ankylosing spondylitis during therapy with adalimumab. Am J Kidney Dis 56:17–21. doi:10.1053/j.ajkd.2010.08.019

    Article  Google Scholar 

  27. Kuhlmann U, Alscher DM (2008) Nephrologie: Pathophysiologie, Klinik, Nierenersatzverfahren Thieme, Stuttgart

  28. Levinson RD, Park MS, Rikkers SM et al (2003) Strong associations between specific HLA-DQ and HLA-DR alleles and the tubulointerstitial nephritis and uveitis syndrome. Invest Ophthalmol Vis Sci 44:653–657

    Article  PubMed  Google Scholar 

  29. Löffler C, Löffler U, Tuleweit A, Waldherr R et al (2015) Renal Sarcoidosis: epidemiological and follow-up data in a cohort of 27 patients. Sarcoidosis Vasc Diffuse Lung Dis 31:306–315

    PubMed  Google Scholar 

  30. Loock J, Manger B (2013) IgG4-related disease. Z Rheumatol 72:151–162. doi:10.1007/s00393-012-1104-7

    Article  CAS  PubMed  Google Scholar 

  31. Mahévas M, Lescure FX, Boffa J-J et al (2009) Renal sarcoidosis: clinical, laboratory, and histologic presentation and outcome in 47 patients. Medicine (Baltimore) 88:98–106. doi:10.1097/MD.0b013e31819de50f

  32. Mahmoudzadeh P, Tousi A, Ramezani A et al (2014) Uveitis profile and treatment response in Iranian patients with sarcoidosis. Int Ophthalmol (Epub ahead of print). doi:10.1007/s10792-014-9960-6

  33. Mandeville JT, Levinson RD, Holland GN (2001) The tubulointerstitial nephritis and uveitis syndrome. Surv Ophthalmol 46:195–208

    Article  CAS  PubMed  Google Scholar 

  34. Mori Y, Kishimoto N, Yamahara H et al (2005) Predominant tubulointerstitial nephritis in a patient with systemic lupus nephritis. Clin Exp Nephrol 9:79–84. doi:10.1007/s10157-004-0338-3

    Article  PubMed  Google Scholar 

  35. Muriithi AK, Leung N, Valeri AM et al (2014) Clinical characteristics, causes and outcomes of acute interstitial nephritis in the elderly. Kidney Int (Epub ahead of print). doi:10.1038/ki.2014.294

  36. Muriithi AK, Nasr SH, Leung N (2013) Utility of urine eosinophils in the diagnosis of acute interstitial nephritis. Clin J Am Soc Nephrol 8:1857–1862. doi:10.2215/CJN.01330213

    Article  PubMed Central  PubMed  Google Scholar 

  37. Okazaki K, Umehara H (2012) Are classification criteria for IgG4-RD now possible? The Concept of IgG4-related disease and proposal of comprehensive diagnostic criteria in Japan. Int J Rheumatol 2012:357071. doi:10.1155/2012/357071

    Article  PubMed Central  PubMed  Google Scholar 

  38. Penn H, Denton CP (2008) Diagnosis, management and prevention of scleroderma renal disease. Curr Opin Rheumatol 20:692–696. doi:10.1097/BOR.0b013e3283108df7

    Article  PubMed  Google Scholar 

  39. Pinto B, Dhir V, Krishnan S, Nada R (2013) Leflunomide-induced DRESS syndrome with renal involvement and vasculitis. Clin Rheumatol 32:689–693. doi:10.1007/s10067-012-2152-8

    Article  PubMed  Google Scholar 

  40. Pirklbauer M, Gruber J (2014) DRESS syndrome following sulfasalazine treatment. Z Rheumatol 73:180–183. doi:10.1007/s00393-013-1308-5

    Article  CAS  PubMed  Google Scholar 

  41. Praga M, Sevillano A, Auñón P, González E (2014) Changes in the aetiology, clinical presentation and management of acute interstitial nephritis, an increasingly common cause of acute kidney injury. Nephrol Dial Transplant (Epub ahead of print). doi:10.1093/ndt/gfu326

  42. Preddie DC, Markowitz GS, Radhakrishnan J et al (2006) Mycophenolate mofetil for the treatment of interstitial nephritis. Clin J Am Soc Nephrol 1:718–722. doi:10.2215/CJN.01711105

    Article  CAS  PubMed  Google Scholar 

  43. Raissian Y, Nasr SH, Larsen CP et al (2011) Diagnosis of IgG4-related tubulointerstitial nephritis. J Am Soc Nephrol 22:1343–1352. doi:10.1681/ASN.2011010062

    Article  PubMed Central  PubMed  Google Scholar 

  44. Ram R, Swarnalatha G, Dakshinamurty KV (2014) Renal tubular acidosis in Sjögren’s syndrome: a case series. Am J Nephrol 40:123–130. doi:10.1159/000365199

    Article  PubMed  Google Scholar 

  45. Ransford RA, Langman MJS (2002) Sulphasalazine and mesalazine: serious adverse reactions re-evaluated on the basis of suspected adverse reaction reports to the Committee on Safety of Medicines. Gut 51:536–539

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  46. Robbins SL, Cotran RS (2004) Robbins and Cotran pathologic basis of disease. Saunders, Philadelphia

  47. Saeki T, Kawano M (2014) IgG4-related kidney disease. Kidney Int 85:251–257. doi:10.1038/ki.2013.393

    Article  CAS  PubMed  Google Scholar 

  48. Shanmugam VK, Steen VD (2012) Renal disease in scleroderma: an update on evaluation, risk stratification, pathogenesis and management. Curr Opin Rheumatol 24:669–676. doi:10.1097/BOR.0b013e3283588dcf

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  49. Skalova S, Dedek P, Pozler O, Podhola M (2009) Mesalazine-induced interstitial nephritis. Ren Fail 31:159–161. doi:10.1080/08860220802595922

    Article  PubMed  Google Scholar 

  50. Sungur G, Hazirolan D, Bilgin G (2013) Pattern of ocular findings in patients with biopsy-proven sarcoidosis in Turkey. Ocul Immunol Inflamm 21:455–461. doi:10.3109/09273948.2013.775311

    Article  PubMed  Google Scholar 

  51. Tan Y, Yu F, Qu Z et al (2011) Modified C-reactive protein might be a target autoantigen of TINU syndrome. Clin J Am Soc Nephrol 6:93–100. doi:10.2215/CJN.09051209

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  52. Trang G, Steele R, Baron M, Hudson M (2012) Corticosteroids and the risk of scleroderma renal crisis: a systematic review. Rheumatol Int 32:645–653. doi:10.1007/s00296-010-1697-6

    Article  CAS  PubMed  Google Scholar 

  53. Valeyre D, Prasse A, Nunes H et al (2014) Sarcoidosis. Lancet 383:1155–1167. doi:10.1016/S0140-6736(13)60680-7

    Article  PubMed  Google Scholar 

  54. Wang C-C, Shiang J-C, Huang W-T, Lin S-H (2010) Hypokalemic paralysis as primary presentation of Fanconi syndrome associated with Sjögren syndrome. J Clin Rheumatol 16:178–180. doi:10.1097/RHU.0b013e3181df903f

    Article  PubMed  Google Scholar 

  55. Weening JJ, D’Agati VD, Schwartz MM et al (2004) The classification of glomerulonephritis in systemic lupus erythematosus revisited. J Am Soc Nephrol 15:241–250

    Article  PubMed  Google Scholar 

  56. Wilson CB (1989) Study of the immunopathogenesis of tubulointerstitial nephritis using model systems. Kidney Int 35:938–953

    Article  CAS  PubMed  Google Scholar 

  57. Witte T (2014) Sjögren’s syndrome. Z Rheumatol 73:49–61. doi:10.1007/s00393-013-1313-8

    Article  CAS  PubMed  Google Scholar 

Download references

Danksagung

Die Autoren danken Frau Dr. E.F. Gröne und Herrn Prof. Dr. H.-J. Gröne, DKFZ Heidelberg, für die Abbildung zur IgG4-assoziierten interstitiellen Nephritis.

Einhaltung ethischer Richtlinien

Interessenkonflikt. P. Korsten und G.A. Müller geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Author information

Authors and Affiliations

  1. Klinik für Nephrologie und Rheumatologie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland

    P. Korsten &  G.A. Müller

Authors
  1. P. Korsten
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G.A. Müller
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G.A. Müller.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Korsten, P., Müller, G. Interstitielle Nephritis bei rheumatischen Erkrankungen. Z Rheumatol 74, 290–299 (2015). https://doi.org/10.1007/s00393-014-1482-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00393-014-1482-0

Schlüsselwörter

Keywords

Search

Navigation