Tubulointerstitial nephropathies

Tubulointerstitial nephropathy is a collective term that includes various kidney diseases that occur with primary damage mainly to the structures of the tubules and interstitium. The main types of tubulointerstitial nephropathy are acute and chronic tubulointerstitial nephritis of various origins, kidney damage due to environmental factors (lead, lithium), and some genetically determined conditions (medullary cystic disease). Some types of tubulointerstitial nephropathy (for example, analgesic, urate) are considered separately due to their significant prevalence in the population and the possibility of effective prevention.

Tubulointerstitial inflammation and fibrosis are also commonly found in chronic kidney disease with primary glomerular involvement, and their intensity is one of the main factors determining the rate of deterioration of renal function.

Inhibition of renal tubulointerstitium remodeling processes is considered one of the most effective methods of slowing the progression of renal failure.

Causes and pathogenesis of tubulointerstitial nephropathy

The causes of chronic tubulointerstitial nephropathy are varied. Most of them cause the development of chronic or, much less frequently, acute interstitial nephritis.

Causes of tubulointerstitial nephropathy

Group	The most common reasons
Medicines	NSAIDs Chemotherapeutic agents (platinum drugs, nitrosoureas) Immunosuppressants (cyclosporine, tacrolimus) Antibiotics Traditional Medicine (Chinese Herbs)
Environmental factors	Lithium Lead Ionizing radiation
Metabolic disorders	Uric acid metabolism disorders Cholesterol crystal embolism of intrarenal arteries Hypercalcemia Hypokalemia Oxaluria
Systemic diseases	Sjogren's disease and syndrome Cryoglobulinemia Systemic vasculitis Sarcoidosis Systemic lupus erythematosus HBV and HCV infections
Infections and infestations	Bacterial Viral Parasitic
Tumors/diseases of the blood system	Sickle cell anemia Multiple myeloma Light chain disease Lymphoproliferative diseases
Hereditary	Hereditary interstitial nephritis with karyomegaly Medullary spongy kidney
Various	Balkan nephropathy Idiopathic tubulointerstitial nephritis

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Classification of tubulointerstitial nephropathies

Tubulointerstitial nephritis:

• Acute tubulointerstitial nephritis.
  • Drug-induced acute tubulointerstitial nephritis.
  • Infectious acute tubulointerstitial nephritis.
  • Acute tubulointerstitial nephritis in systemic diseases.
  • Idiopathic acute tubulointerstitial nephritis.
• Chronic tubulointerstitial nephritis.
  • Chronic drug-induced tubulointerstitial nephritis:
    • analgesic nephropathy;
    • other forms of chronic drug-induced tubulointerstitial nephritis.
  • Chronic tubulointerstitial nephritis due to environmental factors:
    • lithium nephropathy;
    • lead nephropathy;
    • cadmium nephropathy;
    • radiation nephropathy.
  • Chronic tubulointerstitial nephritis in systemic diseases.

Tubulointerstitial nephropathy in metabolic diseases:

• Kidney damage in hypercalcemia.
• Kidney damage in hyperoxaluria.
• Kidney damage due to uric acid metabolism disorders.

Tubulointerstitial nephropathy of unknown origin:

• Endemic Balkan nephropathy.
• Medullary spongy kidney.

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