Tubulointerstitial Kidney Diseases (Interstitial Nephritis)

Tubulointerstitial diseases affect the kidney's tubules and the supporting tissue between them, rather than the filters. The tubules reclaim water, salts and nutrients from filtered fluid, so damage here disturbs the concentration of urine and electrolyte balance, and reduces kidney function.

The acute form, acute interstitial nephritis, is most often an allergic-type reaction to a medicine and usually recovers if caught early. The chronic form develops slowly with scarring and is a common, under-recognised cause of chronic kidney disease.

Symptome

• Often only a rise in creatinine on a blood test
• Fever, rash and joint aches in a minority with drug-induced disease
• Passing large volumes of urine and waking at night to urinate
• Tiredness, nausea and loss of appetite
• Flank discomfort
• Only small amounts of protein in the urine and little or no swelling, unlike glomerular disease
• Painful red eyes (uveitis) in the rare TINU syndrome

Ursachen und Risikofaktoren

Drugs cause more than two thirds of acute cases: antibiotics (penicillins, cephalosporins, ciprofloxacin, rifampicin, sulfonamides), NSAIDs, proton pump inhibitors, allopurinol, diuretics and cancer immunotherapy (checkpoint inhibitors). Other causes are infections, sarcoidosis, Sjogren syndrome, IgG4-related disease and TINU syndrome. Chronic disease follows long-term analgesic or lithium use, reflux and repeated kidney infections, prolonged obstruction, myeloma, gout, lead or cadmium, aristolochic acid in some herbal remedies (the cause of Balkan nephropathy), and inherited tubulointerstitial kidney disease due to genes such as UMOD and MUC1.

Wie es diagnostiziert wird

• Medication timeline: Matching the start of each drug, including over-the-counter ones, with the change in kidney function.
• Urinalysis and microscopy: White cells and white cell casts without infection, mild proteinuria; urine eosinophils are unreliable.
• Blood tests: Creatinine, electrolytes, eosinophil count, calcium, ACE, autoimmune markers, IgG4 and serum free light chains.
• Kidney ultrasound: Normal or enlarged kidneys in acute disease; small, irregular kidneys in chronic disease.
• Kidney biopsy: The only way to confirm the diagnosis; shows inflammatory cells, swelling and the amount of scarring.

Behandlungsmöglichkeiten

• Withdrawal of the causative drug: The essential step, with the drug recorded as an allergy to prevent re-exposure.
• Corticosteroids: A course of prednisolone is often given if function does not improve within about a week of stopping the drug, and is most effective when started early.
• Treatment of underlying disease: Immunosuppression for sarcoidosis, Sjogren syndrome or IgG4 disease; relief of obstruction; chemotherapy for myeloma.
• Supportive care: Fluids, electrolyte correction, blood pressure control and avoidance of further kidney-toxic drugs.
• Temporary dialysis: Occasionally needed in severe acute cases while the kidneys recover.
• Chronic kidney disease care: Long-term monitoring and risk factor control where scarring has occurred.

Wenn es dringend ist

Seek prompt local care if you pass very little urine, develop a widespread rash with fever shortly after starting a new medicine, feel breathless or confused, or have palpitations that may signal an electrolyte disturbance.

Reisen nach Türkiye zur Behandlung

Acute interstitial nephritis needs diagnosis and treatment within days, where you are, because delay increases scarring. For unexplained chronic kidney impairment, a visit may offer a full nephrology assessment with biopsy and, where there is a family history, genetic testing. Bring a complete list of medicines and supplements with start dates, since this history is often what solves the case.

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