"Kidney diseases have reached an epidemic proportion in India. Early identification of cause and /or associated complications /co-morbidities and their effective treatment may lead to recovery of kidney functions in these patients, thus obliviating any further need of Diaylsis / Renal Transplant.”

Kidney failure is invariably synonymous to Dialysis or Kidney Transplant. However, if intervened in time, many a cause of kidney failure can be averted or recovered. This is of great importance to the society at large as cost of Renal Replacement Therapy is well beyond the means of many patients.

THE CASE

A 45 year old healthy CRPF jawan was admitted with a history of moderate grade fever and joint pain for three days. He was experiencing loss of appetite, nausea and vomiting along with haematuria. The patient noticed diminution of urine and as a result, was referred to Nephrology Department of BLK Super Speciality Hospital.





THE PROCEDURE

On consultation with the Nephrology team at BLK Centre for Renal Sciences and Kidney Transplant, it was observed that the patient was significantly uremic displaying symptoms of nausea, vomiting, acidosis, fluid overload and uncontrolled blood pressure. The patient was immediately taken for haemodialysis and stabilised. In view of his short history of renal failure, normal kidney size, the diagnosis of acute kidney injury was made. An ultrasound guided kidney biopsy was done which was suggestive of Acute Interstitial Nephritis most probably due to drugs. The patient was then treated with pulse steroids for 3 days followed by oral steroids in tapering doses.



THE RESULT

The patient has totally recovered his renal function, with his serum creatinine level reduced to 4 mg/dL at the time of discharge and 1.2 mg/dL on follow up.

Acute Interstitial Nephritis is a renal condition causing renal inflammation and decline in renal function. It is most often caused by drugs. Virtually any drug could be the culprit but most commonly implicated drugs such as Pantoprazole, Fluoroquinolones, anti tubercular agents and some antibiotics. Timely diagnosis and treatment is of paramount importance to reverse renal failure. It may otherwise lead to permanent end stage renal failure requiring either lifelong Dialysis or Transplantation.

High index of suspecting "Rapidly Progressing Renal Failure" (RPRF) and losing no time in doing definitive blood tests and kidney biopsy yields optimum results. Awareness and speed of management of RPRF should be comparable to managing acute coronary syndrome.