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Interstitielle Nephritis

Interstitial nephritis

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Zusammenfassung

Die interstitielle Nephritis beschreibt entzündliche Krankheitsentitäten, die im Wesentlichen im tubulointerstitiellen Raum stattfinden. Auslöser für interstitielle Nephritiden sind Medikamente (z. B. Antibiotika, nichtsteroidale Antirheumatika, Protonenpumpenhemmer), Infektionen und Systemerkrankungen. Die Klinik reicht vom asymptomatischen Verlauf über Flankenschmerzen bis zum akuten Nierenversagen. Häufig kommt es zu charakteristischen, detektierbaren tubulären Partialfunktionsstörungen: tubuläre Proteinurie (α1-Mikroglobulin), Hyperphosphaturie mit Hypophosphatämie, Aminoazidurie, verminderte H+-Sekretion mit metabolischer Azidose mit inadäquat hohem Urin-pH-Wert, Glukosurie, Salzverlust. Bei der medikamentös induzierten Form ist das Weglassen des auslösenden Agens oberstes Prinzip, nach Infektionsausschluss hat sich die Gabe von Kortikosteroiden bewährt. In der Mehrzahl der Fälle mit akutem Verlauf ist mit einer günstigen Prognose zu rechnen, bei der chronischen Verlaufsform, bei der auch die Glomeruli betroffen sind, bedarf es aller supportiven Maßnahmen im Sinne der Behandlung der chronischen Niereninsuffizienz, um eine weitere Funktionsverschlechterung bis zur Entwicklung einer ESRD („end-stage renal disease“) abzuwenden.

Abstract

Drugs such as antibiotics, non-steroidal anti-inflammatory drugs and proton pump inhibitors, infections and systemic diseases can trigger interstitial nephritis. The clinical outcome varies from asymptomatic progression to acute kidney injury. Interstitial nephritis often leads to characteristic and detectable partial tubular disorders such as tubular proteinuria (α1-microglobulin), phosphaturia with hypophosphatemia, aminoaciduria, diminished H+ secretion with metabolic acidosis with inadequate high urinary pH, glucosuria and salt loss. The main principle of treatment is avoidance of the inducing agent. In addition corticosteroids have been proven usable after exclusion of an infection so that a good prognosis can be expected for acute nephritis in the majority of cases. In chronic forms the interstitial nephritis involves the glomeruli as well as potentially resulting in end-stage renal failure in the long run. Supportive therapies are then required in the sense of chronic renal failure in order to prevent further functional loss up to end-stage renal disease.

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Authors and Affiliations

  1. Medizinische Klinik und Poliklinik für Endokrinologie und Nephrologie, Department für Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig, A.ö.R., Leipzig, Liebigstr. 20, 04159, Leipzig, Deutschland

    J. Halbritter, C. Mayer, F.M. Rasche &  T.H. Lindner

  2. Nephropathologische Abteilung, Universitätsklinikum Erlangen, Erlangen, Deutschland

    K. Amann

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  1. J. Halbritter
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  2. C. Mayer
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  3. F.M. Rasche
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  5. T.H. Lindner
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Correspondence to T.H. Lindner.

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Halbritter, J., Mayer, C., Rasche, F. et al. Interstitielle Nephritis. Internist 50, 1111–1126 (2009). https://doi.org/10.1007/s00108-009-2463-2

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