Tubulo-interstitial nephropathies

Tubulo-interstitial nephropathy is a collective concept, to which include a variety of kidney diseases that occur with the primary lesion of predominantly tubular structures and interstitium. The main variants of tubulointerstitial nephropathy are acute and chronic tubulointerstitial nephritis of various origin, renal damage due to environmental factors (lead, lithium), as well as some genetically conditioned conditions (medullary cystic disease). Some variants 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, as a rule, also reveal in chronic kidney diseases with primary glomerular lesions, their intensity is one of the main factors determining the rate of impairment of kidney function.

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

The causes and pathogenesis of tubulointerstitial nephropathies

The causes of chronic tubulointerstitial nephropathy are diverse. Most of them cause the development of chronic or, rarely, acute interstitial nephritis.

Causes of tubulointerstitial nephropathy

Group	Common causes
Medications	NSAIDs Chemotherapeutic agents (platinum preparations, nitrosoureas) Immunosuppressants (cyclosporine, tacrolimus) Antibiotics Means of traditional medicine (Chinese herbs)
Environmental factors	Lithium Lead Ionizing radiation
Exchange violations	Disorders of uric acid metabolism Embolism with crystals of cholesterol of the intrarenal arteries Hypercalcemia Hypokalemia Oxaluria
Systemic diseases	Disease and Sjogren's syndrome Cryoglobulinemia Systemic vasculitis Sarcoidosis Systemic lupus erythematosus HBV and HCV infections
Infections and invasions	Bacterial Viral Parasitic
Tumors / diseases of the blood system	Sickle cell anemia Multiple myeloma Disease of lung chains Lymphoproliferative diseases
Hereditary	Hereditary interstitial nephritis with karyomegaly Medullary spongy kidney
Various	Balkan Nephropathy Idiopathic tubulointerstitial nephritis

[1], [2], [3], [4], [5], [6],

Classification of tubulointerstitial nephropathies

Tubulointerstitial nephritis:

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

Tubulointerstitial nephropathies in metabolic diseases:

• Renal damage in hypercalcemia.
• Kidney damage in hyperoxaluria.
• Kidney damage in cases of impaired uric acid metabolism.

Tubulointerstitial nephropathies of unknown origin:

• Endemic Balkan Nephropathy.
• Medullary spongy kidney.

[7], [8], [9], [10]