The Pathology of Acute Renal Failure Due to Interstitial Nephritis in Man with Comments on the Role of Interstitial Inflammation and Sex in Gentamicin Nephrotoxicity

Abstract

Patients (29) with acute renal failure and biopsy-proven acute interstitial nephritis were investigated. Histologic changes (26) were assessed. To investigate further the possibility that interstitial inflammation played a more important role in renal failure in gentamicin[antibiotic]-treated females than in gentamicin-treated males, studies were carried out in female and male Fischer rats treated with gentamicin (40 mg/kg per day) for 8 days. Interstitial inflammation was significantly greater in the female rats even though the renal failure was significantly more severe in the male rats. In females there was a significant correlation between interstitial inflammation and level of serum creatinine suggesting that the inflammation was intimately related to the renal failure, while in males no such correlation existed. The interstitial inflammation in gentamicin-treated females may represent an autoimmune or chemotactic reaction to antigens and other substances released by damaged proximal tubular cells. Other possible etiologies were discussed.