P86 Idiopathic interstitial nephritis (IN) leading to end stage kidney disease (ESKD) in a 17-year-old male
| Autor: | Syed Ali Aown, James Dillon, Eoin Bergin, Shodan Osman |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Creatinine
Pediatrics medicine.medical_specialty Proteinuria medicine.diagnostic_test business.industry medicine.medical_treatment Acute kidney injury medicine.disease Transplantation chemistry.chemical_compound chemistry medicine Renal fibrosis Renal biopsy medicine.symptom business Dialysis Kidney disease |
| Zdroj: | Abstracts. |
| DOI: | 10.1136/archdischild-2019-epa.441 |
| Popis: | Background IN, a clinical syndrome of numerous aetiologies including infectious, medication and sometimes idiopathic, is a common cause of acute kidney injury, which is often under-diagnosed. Its incidence has decreased over the last number of years which is thought to be due to the increase use and early implementation of antimicrobials in the, given that infection is one of its leading causes, (Raina, et al., 2016). IN is associated with an immune-mediated infiltration which can lead to fibrosis of the interstitium and ultimately cause chronic kidney disease. Early diagnosis is key to limit renal impairment. Presentation can be quite non-specific: patients often complaining of fatigue or malaise over a number of weeks. This non-specific nature delays diagnosis and ultimately a progression in renal impairment. Treatment is highly dependent on the underlying aetiology, but IN has shown to be quite responsive to steroids. The prognosis of IN depends on the underlying cause as well as timing of intervention. Evidence of a chronic course as well as gross proteinuria, indicate of a poorer prognosis. Biopsy proven renal fibrosis represents irreversible change, (Joyce, et al., 2018). Unfortunately, a delayed diagnosis has the potential to cause ESKD, (Nangaku, 2004). Clinical Case Our case represents a previously fit 17-year-old male. Retrospectively admitting to some fatigue, he was actively playing sports with no background/family history. Blood tests performed at a GP practice, at the time of investigation for a swollen knee/sports injury, reported a serum creatinine > 1000µmol/L and subsequent urine analysis reported >3 g of protein in 24 hours. Dialysis was initiated due hyperkalaemia, rising creatinine and uraemia and a renal biopsy reported greater than 90% fibrosis. A PTH level was reported greater than 300ng/L, indicating that renal impairment had been progressing for some time. Initial vasculitic and autoimmune serology have all been reported as negative, and our patient is currently being worked up for a renal transplant. Discussion This case represents ESKD due to idiopathic IN. IN is steroid responsive and when diagnosed and treated promptly, renal impairment can be limited. Unfortunately, in our case, there was no indication to perform urine or serum analysis, which may have prompted earlier intervention. This highlights the possible benefits for routine screening in the community. As well as medical issues associated with renal impairment and transplantation there are also huge psychosocial implications for an adolescent including compliance with medications and self-image post transplantation, (Abdel-Kader, et al., 2009) . |
| Databáze: | OpenAIRE |
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