Acute diffuse interstitial nephritis: Review of the literature and case report

Abstract A case of acute oliguric renal failure due to acute diffuse interstitial nephritis is described. Of the possible pathogenetic mechanisms regarded as responsible for the unusual renal lesion in this case, sensitivity to methicillin is considered the most likely. Despite the alarming histologic pattern which characterizes this diffuse interstitial lesion, careful observation usually reveals minimal damage to the parenchyma. This suggests a high degree of reversibility of the lesion, even though the intense cellular infiltration of the interstitial tissue may be accompanied by focal necrosis of tubules and hemorrhage. Thus, efforts to tide the patient over an oliguric or anuric period with dialysis and other measures employed in acute renal failure are likely to be rewarding. The additional manifestation of ureteral inflammation as part of the hypersensitivity reaction, causing possible obstruction, is discussed. Acute diffuse interstitial nephritis was more common before the introduction of drugs to control streptococcal and other infections which were causally related to this lesion in the past. However, the wider use of antibiotics and other drugs carries with it the hazard of sensitivity reactions which may result in this form of nephritis.