The first well-described cases of AIN were not secondary to adverse drug reactions but were found at autopsy of patients who had died of scarlet fever or diphtheria. This adverse renal reaction has been associated with bacterial, viral, and parasitic infections, including streptococcal infections, diphtheria, leptospirosis, leishmaniasis, toxoplasmosis, infectious mononucleosis, Epstein-Barr virus infection, measles, brucellosis, syphilis, mycoplasmal pneumonia, infections with HIV, Kawasaki disease, and Legionnaires' disease. Some infectious agents, such as those responsible for leptospirosis, mycobacterial infections, cytomegalovirus infection, Rocky Mountain spotted fever, and Hantaan virus infection, may directly infect the kidney and cause interstitial inflammation during the course of systemic infection. The acute inflammatory infiltrate can be composed of lymphocytes, plasma cells, monocytes, and polymorphonuclear cells, but eosinophils are not commonly found. The acute renal dysfunction is manifested by an acute decrease in the GFR or isolated tubular defects.
All manifestations generally resolve if the systemic infection is successfully treated.