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Tubulointerstitial Diseases of the Kidney

Primary tubulointerstitial diseases of the kidneyare characterized by abnormalities of structure and function of tubules and the interstitium.
The glomeruli and renal vasculature are involved to a Jesser extent.
The biopsy specimens and the urine sediments do not help in diagnosis.
Acute interstitial nephritis (AIN) is most often induced by drug therapy

there is hypokalemia, glycosuria, phosphaturia, uricosuria,
bicarbonaturia, aminoaciduria, like in proximal or type 11 renal tubular acidosis (RTA).
The proteinuria is usually less than 2 gjday.
These findings are called the Fanconi syndrome.
There is hyperch/oremic metabolic acidosis and urine pH is less than 5.3.
There is a reduce,d excretion of ammonia.
There may be no turia and polyuria as in analgesic nephropathy and sickle cell disease.

Acute interstitial nephritis may be caused by beta lactam antibiotics, sulphonamides, quinoiones, vancomycin, erythromycin, rifampicin, ethambutol, acyclovir.
Non steroidal antiinflmmatory drugs.
Diuretics – thiazides, frusemide, triamterene.
Anticonvulsants – Phenytoin, phenobarbitol, carbamazepine.
Captopril, Omeprazoie, Allopurinol.
Infections (bacteria) – Streptococcus, staphylococcus, salmonella, brucella.
Viruses – Epstein Barr virus, Cytomegalovirus,
HIV.
Leptospira, Rickettsia, Mycoplasma.
Sarcoidosis.
Antitubule basement membrane disease.

Treatment is management ofthe presenting feertures, withdrawal of the offending drug or agent, treatment of the etiology, dialysis, and renal transplant.