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.


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