Tubulointerstitial disease

Question 1

What is the most common tubulointerstitial disease?

Answer 1

Interstitial nephritis

Question 2

Diseases affecting the renal interstitium and tubules can present with…?

Answer 2

Renal impairment, haematuria, proteinuria, tubular syndromes, abnormalities in electrolyte balance.

Question 3

What can cause acute interstitial nephritis?

Answer 3

Drug hypersensitivity- e.g. NSAIDs, antibiotics.
Infection- CMV, leptospirosis, hantavirus.

Can also occur conjunction with other illnesses such as Sjogrens disease or with uveitis (TINU syndrome)

Question 4

What can cause chronic interstitial nephritis?

Answer 4

Analgesics
Reflux nephropathy
Obstructive uropathy
Primary glomerular disease

Rarer:
Sarcoidosis
Ischaemia
hyperuricemia
Myeloma
Chronic hypokalaemia
Chronic poisoning with heavy metals

Question 5

What features typically point to glomerulonephritis rather than tubulointerstitial disease?

Answer 5

Proteinuria >1g/day
Hypertension (happens in both, but more common in GN)
Red blood cells and casts in urine
Renal biopsy showing glomerular involvement primarily.