Nephro- Tubulointerstitial disease

What is acute tubulointerstitial disease most commonly associated with?

Toxins & ischemia

What is seen on histology with tubulointerstitial disease?

interstitial edema, infiltration w/ PMNs (eos), tubular cell necrosis, glomerular sclerosis, interstitial fibrosis, tubular atrophy

What are the essentials of diagnosis of chronic tubulointerstitial disease?

Small kidney size, dec urinary concentrating ability, hyperchloremic metabolic acidosis, hyperkalemia, reduced GFR

What are the 4 main causes of chronic tubulointerstitial disease?

Obstructive uropathy, vesicoureteral reflux, analgesics, heavy metals

What is the MCC of chronic tubulointerstitial disease?

Obstructive uropathy

What are major causes of obstructive uropathy?

Prostatic disease, B/L ureteral calculi, carcinoma of cervix/colon/bladder, retroperitoneal tumors or fibrosis

What is primary a d/o of childhood that occurs when urine passes retrograde from bladder to kidneys during voiding, secondary to incompetent vesicoureteral sphincter?

*2nd MCC of chronic tubulointerstitial disease

Vesicoureteral reflux

Which analgesic is the most of concern for causing chronic tubulointerstitial disease?

NSAIDs

What would be seen on pathologic examination on NSAID-induced chronic tubulointerstitial disease?

Tubulointerstitial inflammation & papillary necrosis

What is the presentation of analgesic induced chronic tubulointerstitial disease?

Hematuria, mild proteinuria, polyuria, anemia, sterile pyuria, & sloughed papillae in urine (from papillary necrosis)

What can analgesic nephropathy lead to?

Renal failure & cancer

How do heavy metals (lead, gold, mercury, etc) cause chronic tubulointerstitial disease?

Filtered by glomerulus & transported across proximal convoluted tubule → accumulates & causes cell damage

What are ssx of chronic tubulointerstitial disease?

Polyria (inability to concentrate urine), dehydration (salt wasting defect), HTN as pt approaches ESRD

What lab findings are consistent with tubulointerstitial disease?

Hyperkalemia (> 5.0), hyperchloremic metabolic acidosis, microscopic hematuria & pyruia, broad waxy casts, PMNs, occasional eosinophils

How does chronic tubulointerstitial disease appear on US?

Shrunken kidneys

What is the treatment for obstructive induce tubulointerstitial disease?

ID → remove from exposure

Hydronephorsis → relieve obstruction ASAP

*nothing can prevent ESRD once evidence of loss of prenchyma

What is the treatment for drug induced tubulointerstitial disease?

Withhold all analgesics, chelation therapy w/ EDTA

What is a capture of positively charged metal ions by a large molecule?

Chelation