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Related Concept Videos

Acute Kidney Injury II: Pathophysiology01:29

Acute Kidney Injury II: Pathophysiology

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Acute kidney injury (AKI) causes are categorized into three primary categories based on the location of the injury: prerenal, intrarenal (or intrinsic), and postrenal causes. This classification guides clinical management and illustrates how different pathways can impair kidney function.Etiology and Pathophysiology of Acute Kidney Injury1. Prerenal causesEtiology: Prerenal Acute Kidney Injury, the most common type, occurs when reduced blood flow to the kidneys decreases filtration capacity...
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Acute Pyelonephritis I: Introduction01:27

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Pyelonephritis is a bacterial infection that primarily affects the renal parenchyma and collecting system, including the renal pelvis, tubules, and interstitial tissue of one or both kidneys. It can be classified as either acute—a sudden, severe infection—or chronic, which refers to long-term or recurrent kidney infections.The primary cause of acute pyelonephritis (APN) is bacterial infection, with Escherichia coli accounting for approximately 70-80% of cases. Other bacteria, such...
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Nephrotic Syndrome I : Introduction01:24

Nephrotic Syndrome I : Introduction

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Nephrotic Syndrome is a chronic kidney disorder defined by clinical findings such as severe proteinuria, hypoalbuminemia, hyperlipidemia, and edema. These symptoms result from damage to the glomeruli, the kidney’s filtering units, increasing their permeability to proteins.Definition and Meaning:Proteinuria, defined as the loss of more than 3.5 grams of protein per day in adults, is a crucial feature of nephrotic syndrome. This condition is often accompanied by edema, the accumulation of...
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Acute Pyelonephritis II: Diagnostic Studies and Management01:28

Acute Pyelonephritis II: Diagnostic Studies and Management

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Introduction:For diagnosing acute pyelonephritis, a comprehensive patient history is collected to identify symptoms such as dysuria, frequent or urgent urination, flank pain, or costovertebral angle (CVA) tenderness that may suggest a kidney infection.Physical ExaminationDuring the physical examination, CVA tenderness is assessed. This involves gentle percussion over the costovertebral angle, where tenderness often indicates a kidney infection.Diagnostic TestsUrinalysis: Used to identify white...
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Acute Kidney Injury IV: Diagnostic Studies and Prevention01:30

Acute Kidney Injury IV: Diagnostic Studies and Prevention

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Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
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Acute Kidney Injury I: Introduction01:22

Acute Kidney Injury I: Introduction

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Introduction:Acute Kidney Injury (AKI) describes a swift decrease in kidney function occurring over hours to days, characterized by the kidneys' failure to remove waste products from the bloodstream. This leads to dangerous complications like metabolic acidosis, fluid overload, and electrolyte imbalances, such as hyperkalemia, which can cause life-threatening arrhythmias. AKI is common in both hospital and outpatient settings, often triggered by dehydration, sepsis, or exposure to nephrotoxic...
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Updated: Nov 18, 2025

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Recurrent acute interstitial nephritis: what lies beneath.

Fernando Caravaca-Fontán1,2, Amir Shabaka3, Beatriz Sánchez-Álamo3

  • 1Department of Nephrology, Instituto de Investigación, Hospital Universitario 12 de Octubre, Madrid, Spain.

Clinical Kidney Journal
|February 10, 2021
PubMed
Summary

Recurrent acute interstitial nephritis (RAIN) is uncommon but significantly increases the risk of chronic kidney disease. Identifying underlying causes beyond drug exposure is crucial for managing RAIN and improving kidney survival.

Keywords:
acute interstitial nephritischronic kidney diseaserecurrent acute interstitial nephritis

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Area of Science:

  • Nephrology
  • Internal Medicine
  • Pathology

Background:

  • Acute interstitial nephritis (AIN) is an increasingly recognized cause of acute kidney injury.
  • While typically acute, AIN can recur, posing significant clinical challenges.

Purpose of the Study:

  • To investigate the incidence, causes, treatment, and outcomes of recurrent acute interstitial nephritis (RAIN).
  • To determine the association between RAIN and the progression to advanced chronic kidney disease (CKD).

Main Methods:

  • A retrospective, observational cohort study.
  • Inclusion of 205 patients with biopsy-proven AIN across 13 Spanish nephrology departments (1996-2018).

Main Results:

  • Twenty-two patients (10.7%) developed RAIN, often linked to drug reintroduction, systemic diseases (sarcoidosis, Sjögren's syndrome), or unidentified causes.
  • RAIN was independently associated with a higher risk of progressing to Stages 4 and 5 chronic kidney disease (CKD).
  • Microscopic hematuria was more frequent in RAIN patients with systemic diseases.

Conclusions:

  • Recurrent acute interstitial nephritis is infrequent but linked to poor kidney survival.
  • Clinicians should investigate underlying etiologies for RAIN beyond drug-induced causes.
  • A significant proportion of RAIN cases remain without an identified specific cause.