Skip to Main Content

For further information, see CMDT Part 24-23: Chronic Tubulointerstitial Diseases

KEY FEATURES

Essentials of Diagnosis

  • Kidney size is small and contracted

  • Decreased urinary concentrating ability

  • Chronic kidney disease (CKD)

General Considerations

  • Obstructive uropathy

    • Common cause of chronic tubulointerstitial disease

    • May result from prolonged or recurrent urinary obstruction

    • Causes of obstructive uropathy include

      • Prostate disease in men

      • Ureteral calculus in a single functioning kidney

      • Bilateral ureteral calculi

      • Carcinoma of the cervix, colon, or bladder

      • Retroperitoneal tumors or fibrosis

  • Vesicoureteral reflux

    • Occurs when an incompetent vesicoureteral sphincter allows urine from the bladder to reflux up the ureter to the kidney during voiding

    • Urine can extravasate into the interstitium, triggering an inflammatory response that leads to fibrosis over time

  • Analgesic nephropathy

    • Most commonly seen in patients who ingest large quantities of anti-inflammatory pain medications

    • Medications of concern are paracetamol, aspirin, and other nonsteroidal anti-inflammatory drugs (NSAIDs); acetaminophen is a possible but less certain culprit

    • Kidney dysfunction occurs after ingestion of at least 1 g/d for 3 years of these analgesics; many patients underestimate their analgesic use

  • Heavy metals

    • Environmental exposure to lead, cadmium, mercury, and bismuth can cause tubulointerstitial disease but is seen infrequently in the United States

    • Individuals at risk for lead-induced tubulointerstitial disease are those with occupational exposure (eg, welders, or those who work with lead-based paint or leaded-gasoline) and drinkers of alcohol distilled in automobile radiators ("moonshine" whiskey users)

  • Mesoamerican nephropathy

    • A form of chronic tubulointerstitial disease disproportionately affecting male agricultural workers in Central America is an important cause of end-stage kidney disease (ESKD)

    • Exact pathophysiology is still unknown

    • Affected individuals tend to be age 30–50 years without diabetes, hypertension, or other causes of kidney disease who work under hot conditions, particularly in sugar cane or cotton fields, and thus are susceptible to dehydration

  • Balkan nephropathy

    • Endemic to the Danube region

    • Affected individuals are usually 50–60 years of age and have been exposed to aristolochic acid, typically in contaminated wheat products

  • Autosomal dominant tubulointerstitial disease is a rare but increasingly recognized cause of heritable kidney disease; it may be caused by defects in one of several genes, and the clinical presentation varies with the pathogenic variant

CLINICAL FINDINGS

Symptoms and Signs

  • Polyuria may occur if tubular damage leads to nephrogenic diabetes insipidus, possibly from vasopressin insensitivity

  • Volume depletion can rarely occur as a result of a salt-wasting defect in some individuals

  • Obstructive uropathy

    • In partial obstruction, patients can exhibit

      • Polyuria (from tubular damage) or

      • Oliguria (due to decreased glomerular filtration rate [GFR])

    • Azotemia and hypertension (due to increased renin-angiotensin production) are usually present

    • Abdominal, rectal, and genitourinary examinations may detect distended bladder or large prostate

  • Vesicoureteral reflux

    • Typically diagnosed in young children with a history of recurrent urinary tract infections

    • Can develop after kidney transplantation

    • Hypertension

    • Substantial proteinuria

  • Analgesics

    • Hematuria

    • Mild proteinuria

    • Polyuria ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.

  • Create a Free Profile