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Tubulointerstitial Nephritis

Updated : April 29, 2024





Background

Tubulointerstitial nephritis is a renal disease related with Epstein-Barr virus and responsible to cause renal failure and then bilateral uveitis.  

Inflammatory infiltrates including lymphocytes, plasma cells, and macrophages, are present in renal tissue which causes impaired renal function. 

Epidemiology

These diseases affect 10% to 15% of kidney disease cases worldwide. They are more prevalent in women due to higher intake of analgesic is observed in them. 

Toxic nephropathies which are related with lead are more prevalent with advancing age due to the cumulative effects of toxic substances. 

Anatomy

Pathophysiology

Kidney cell injury can lead to the expression of new local antigens, and inflammatory cell infiltration. 

Acute interstitial nephritis causes renal tubular dysfunction, reversible regardless of epithelium damage may be due to capacity of preserved basement membrane tubule. 

Etiology

Tubulointerstitial kidney diseases is caused due to various factors including drug or heavy metal exposure and it can present as acute or chronic conditions as well. 

Genetics

Prognostic Factors

Tubulointerstitial disease can lead to ESRD which is required in dialysis, electrolyte and acid-base disorders. 

Patients with renal function disorder and mild tubular injury usually have a better prognosis and is increased by identification and suitable treatment. 

Clinical History

Tubulointerstitial nephritis can affect individuals of all age groups from children to infants also seen in adults with middle-aged individuals. 

Physical Examination

  • Abdominal examination  
  • Genitourinary System assessment  
  • Neurological Examination 

Age group

Associated comorbidity

Associated activity

Acuity of presentation

This condition of kidney disorder is asymptomatic in its early stages which can be acute or chronic with symptoms developing gradually over months to years and they discovered through routine laboratory testing. 

Differential Diagnoses

  • Acute Interstitial Nephritis 
  • Acute and chronic Kidney Injury  
  • Glomerulonephritis 

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

In treatment phase physician should discontinue all medication which causes damage to patient’s renal health.   

Supportive measures should take in cases with severe renal impairment or electrolyte imbalances. 

Follow up studies and evaluation of clinical status are required. Appointments with medical physicians and preventing recurrence of infection is an ongoing life-long effort. 

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Use of a non-pharmacological approach for Tubulointerstitial Nephritis

Patients should avoid taking nephrotoxic drugs whenever possible including OTC medications. 

Patients should increase level of fluid intake during situations where more fluid loss occurs. 

Patients should strictly follow a balanced diet including rich in fruits, vegetables, and lean proteins. 

Use of Glucocorticoids for treatment of Tubulointerstitial Nephritis

Prednisone: It has anti-inflammatory effects which suppress the immune response and inhibits the production of inflammatory cytokines.  

 

Use of chelating agent for treatment of Tubulointerstitial Nephritis

Succimer: It is a chelating agent which binds with heavy metals e.g., lead and promotes their excretion through urine. 

Use of Intervention with a procedure in treating Tubulointerstitial Nephritis

Renal biopsy is the standard diagnostic procedure which involves a histopathologic examination of renal tissue to assess inflammation and fibrosis. 

Ultrasound, computed tomography, and magnetic resonance imaging these tests are used to evaluate tubulointerstitial nephritis and to assess renal size and structural abnormalities. 

 

Use of phases in managing Tubulointerstitial Nephritis

A detailed family history and physical examination of patient is conducted by healthcare specialist in diagnosis phase to identify signs and symptoms of specific disorder. 

In next phase, an imaging study is performed to confirm the presence of tubulointerstitial nephritis and its related symptoms to guide the treatment.  

Supportive measures including intravenous fluids and electrolyte supplement are given to stabilize and optimize renal function of patient. 

Medication

Media Gallary

Tubulointerstitial Nephritis

Updated : April 29, 2024




Tubulointerstitial nephritis is a renal disease related with Epstein-Barr virus and responsible to cause renal failure and then bilateral uveitis.  

Inflammatory infiltrates including lymphocytes, plasma cells, and macrophages, are present in renal tissue which causes impaired renal function. 

These diseases affect 10% to 15% of kidney disease cases worldwide. They are more prevalent in women due to higher intake of analgesic is observed in them. 

Toxic nephropathies which are related with lead are more prevalent with advancing age due to the cumulative effects of toxic substances. 

Kidney cell injury can lead to the expression of new local antigens, and inflammatory cell infiltration. 

Acute interstitial nephritis causes renal tubular dysfunction, reversible regardless of epithelium damage may be due to capacity of preserved basement membrane tubule. 

Tubulointerstitial kidney diseases is caused due to various factors including drug or heavy metal exposure and it can present as acute or chronic conditions as well. 

Tubulointerstitial disease can lead to ESRD which is required in dialysis, electrolyte and acid-base disorders. 

Patients with renal function disorder and mild tubular injury usually have a better prognosis and is increased by identification and suitable treatment. 

Tubulointerstitial nephritis can affect individuals of all age groups from children to infants also seen in adults with middle-aged individuals. 

  • Abdominal examination  
  • Genitourinary System assessment  
  • Neurological Examination 

This condition of kidney disorder is asymptomatic in its early stages which can be acute or chronic with symptoms developing gradually over months to years and they discovered through routine laboratory testing. 

  • Acute Interstitial Nephritis 
  • Acute and chronic Kidney Injury  
  • Glomerulonephritis 

In treatment phase physician should discontinue all medication which causes damage to patient’s renal health.   

Supportive measures should take in cases with severe renal impairment or electrolyte imbalances. 

Follow up studies and evaluation of clinical status are required. Appointments with medical physicians and preventing recurrence of infection is an ongoing life-long effort. 

Patients should avoid taking nephrotoxic drugs whenever possible including OTC medications. 

Patients should increase level of fluid intake during situations where more fluid loss occurs. 

Patients should strictly follow a balanced diet including rich in fruits, vegetables, and lean proteins. 

Prednisone: It has anti-inflammatory effects which suppress the immune response and inhibits the production of inflammatory cytokines.  

 

Succimer: It is a chelating agent which binds with heavy metals e.g., lead and promotes their excretion through urine. 

Renal biopsy is the standard diagnostic procedure which involves a histopathologic examination of renal tissue to assess inflammation and fibrosis. 

Ultrasound, computed tomography, and magnetic resonance imaging these tests are used to evaluate tubulointerstitial nephritis and to assess renal size and structural abnormalities. 

 

A detailed family history and physical examination of patient is conducted by healthcare specialist in diagnosis phase to identify signs and symptoms of specific disorder. 

In next phase, an imaging study is performed to confirm the presence of tubulointerstitial nephritis and its related symptoms to guide the treatment.  

Supportive measures including intravenous fluids and electrolyte supplement are given to stabilize and optimize renal function of patient.