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Chronic tubulointerstitial nephritis
Last reviewed: 04.07.2025
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Causes chronic tubulointerstitial nephritis.
Chronic tubulointerstitial nephritis (drug form), unlike many other forms of chronic nephropathy, is potentially preventable. Most cases are associated with long-term use of NSAIDs and non-narcotic analgesics; the term analgesic nephropathy is used to describe them.
The development of analgesic chronic tubulointerstitial nephritis is caused by chronic blockade of renal prostaglandin synthesis under the action of NSAIDs and non-narcotic analgesics, accompanied by significant deterioration of renal hemodynamics with ischemia mainly of tubulointerstitial structures. Progressive tubulointerstitial inflammation and fibrosis lead to irreversible deterioration of renal function. In addition, a characteristic feature of analgesic nephropathy is calcification of the renal papillae. Pronounced carcinogenic action is attributed to N-hydroxylated metabolites of phenacetin.
Symptoms chronic tubulointerstitial nephritis.
Chronic tubulointerstitial nephritis is one of the variants of nephrotoxic action of cyclosporine and tacrolimus. Arterial hypertension and slowly progressive renal failure are characteristic. The risk of damage to the renal tubulointerstitium when prescribing tacrolimus is less than cyclosporine.
Chronic tubulointerstitial nephritis is observed in patients taking Chinese herbs, in particular those intended for the treatment of obesity, as well as those used as immunomodulators.
Rapid development of terminal renal failure was noted in some patients. Renal dysfunction of varying severity was observed in all patients.
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Where does it hurt?
Diagnostics chronic tubulointerstitial nephritis.
Diagnosis of chronic tubulointerstitial nephritis requires a detailed study of the anamnesis. In analgesic nephropathy, even at the preclinical stage, the Zimnitsky test reveals a depression of the relative density of urine in most patients. Moderate urinary syndrome (microhematuria, moderate proteinuria) is characteristic. A significant increase in protein excretion with urine indicates the development of severe glomerular damage (most often focal segmental glomerulosclerosis), heralding the development of terminal renal failure.
The addition of macrohematuria is a sign of developing necrosis of the renal papillae; if it persists, it is necessary to exclude uroepithelial carcinoma, the risk of which is very high in analgesic nephropathy, especially in smokers. Aseptic ("sterile") leukocyturia is characteristic of analgesic nephropathy.
What do need to examine?
What tests are needed?
Who to contact?
Treatment chronic tubulointerstitial nephritis.
Treatment of chronic tubulointerstitial nephritis requires taking into account the presence of concomitant factors that can increase the severity of kidney damage:
- chronic heart failure;
- diabetes mellitus type 2;
- uric acid metabolism disorders.
In the elderly, a combination of several forms of kidney damage (“multimorbidity”) is possible, for example, analgesic and urate, diabetic nephropathy, as well as ischemic kidney disease and chronic pyelonephritis.