Tubulointerstitial Diseases of the Kidney

  • Primary tubulointerstitial diseases of the kid­neyare characterized by abnormalities of struture 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
Tubular Diseases of the Kidney2

Treatment of Tubulointerstitial Diseases

In proximal tubule dysfunction

  • 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.

Causes of acute interstitial nephritis

  •   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.

Causes of chronic tubulo interstitial diseases

  • 1. Polycystic kidney
  • 2. Medullary sponge kidney
  • 3. Analgesic nephropathy
  • 4. Lead nephropathy
  • 5. Hyperuricemia
  • 6. Hypercalcemia
  • 7. Hypokalemia
  • 8. Fabry’s disease
  • 9.. Sjogren’s syndrome
  • 10. Leukemia
  • 11. Multiple myeloma
  • 12. Sickle cell disease
  • 13. Chronic pyelonephritis
  • 14. Radiation nephritis.

Treatment of Tubulointerstitial Diseases

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

We would like to keep you updated with special notifications.