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Tubulointerstitial Disease
TUBULOINTERSTITIAL NEPHRITIS
Definition
cellular infiltrates affecting primarily the renal interstitium and tubular cells
functional tubule defects are disproportionately greater than the decrease in GFR
classified as acute or chronic
Signs and Symptoms
manifestation of disease depends on site of tubule affected
1. proximal tubule (e.g. multiple myeloma, heavy metals)
Fanconi syndrome: decreased reabsorption in proximal tubule causing glycosuria,
aminoaciduria, phosphaturia, hypouricemia
proximal RTA (decreased bicarbonate absorption): Type II RTA
2. distal tubule (e.g. amyloidosis, obstruction)
distal RTA (Type I RTA), usually hypokalemic
Na+-wasting nephropathy
hyperkalemia leading to type IV RTA (where reduced renal bicarbonate production is
caused by hyperkalemia)
3. collecting duct (e.g. sickle cell anemia, analgesics, PCKD)
urinary concentrating defect leading to mild nephrogenic DI
polyuria
1. ACUTE TUBULOINTERSTITIAL NEPHRITIS
Definition
rapid (days to weeks) decline in renal function
10-20% of all AKI
Etiology
hypersensitivity
1. antibiotics: -lactams, sulfonamides, rifampin, quinolones, cephalosporins
2. other: NSAIDs, allopurinol, furosemide, thiazides, triamterene, PPIs, acyclovir, phenytoin,
cimetidine
infections
bacterial pyelonephritis, Streptococcus, brucellosis, Legionella, CMV, EBV, toxoplasmosis,
leptospirosis
immune
SLE, acute allograft rejection, Sjgrens syndrome, sarcoidosis, mixed essential
cryoglobulinemia
idiopathic
Pathophysiology
acute inflammatory cell infiltrates into renal interstitium