Kidney nontumor
Tubulointerstitial disease
Other tubular and interstitial disease
Tubulointerstitial nephritis

Topic Completed: 3 December 2012

Minor changes: 12 November 2020

Copyright: 2002-2021,, Inc.

PubMed Search: Tubulointerstitial nephritis [title]

Nikhil Sangle, M.D.
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Cite this page: Sangle N. Tubulointerstitial nephritis. website. Accessed March 8th, 2021.
Acute allergic tubulointerstitial nephritis
  • Drug reaction to beta lactam antibiotics, non-steroidal anti-inflammatory drugs, diuretics, other drugs; generally after 2 – 3 weeks after exposure
  • May occur in renal allografts (Clin Nephrol 2009;72:331)
  • Fever, hematuria, azotemia and eosinophilia
  • Variable skin rash
  • May be associated with inactive cytochrome P450 polymorphisms (Ren Fail 2009;31:749)
  • Urinalysis: suggestive of infection (eosinophils, hematuria, proteinuria, pyuria), but culture negative
Drug toxicity
  • Acute drug-induced interstitial nephritis, typically arises 15 days after exposure, non dosage related
  • May be a delayed (type IV) hypersensitivity reaction, due to hapten like effect of drug, which binds to tubular epithelium, making it immunogenic
  • Rash, fever, eosinophilia, hematuria, mild proteinuria
  • 50% have rising creatinine or develop acute renal failure
  • Common offending drugs are cimetidine, penicillin, phenylbutzaone, rifampin, thiazides
  • Treatment: stop offending drug, but some patients have delayed recovery (Am J Med Sci 2012;343:36)
Granulomatous interstitial nephritis
  • Rare disorder, often due to drugs (aspirin, gentamycin), infections (E. coli, mycobacteria), sarcoidosis (Am J Kidney Dis 2012;59:303), granulomatosis with polyangiitis (Wegener's), oxalosis secondary to intestinal bypass (Hum Pathol 1995;26:1347)
  • Treatment: steroids for idiopathic disease
Case reports
Microscopic (histologic) description
  • Acute allergic tubulointerstitial nephritis
    • Generalized interstitial edema and infiltration by lymphocytes, plasma cells, macrophages and eosinophils
    • Tubular epithelial damage (tubulitis) with luminal white blood cells; variable degree of tubular injury
    • Normal glomeruli and vessels
  • Drug toxicity
    • Edematous interstitium containing abundant eosinophils and neutrophils, lymphocytes, macrophages
    • Also basophils and plasma cells, occasionally granulomas after methicillin
    • Tubular necrosis and regeneration present; glomeruli are normal
  • Granulomatous interstitial nephritis
    • Usually granulomas, T cells and macrophages; rarely neutrophils
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