Kidney nontumor
Tubulointerstitial disease
Other tubular and interstitial disease
Tubulointerstitial nephritis
Author: Nikhil Sangle, M.D.
Topic Completed: 3 December 2012
Minor changes: 12 November 2020
Copyright: 2002-2021, PathologyOutlines.com, Inc.
PubMed Search: Tubulointerstitial nephritis [title]
Table of Contents
Acute allergic tubulointerstitial nephritis | Drug toxicity | Granulomatous interstitial nephritis | Case reports | Microscopic (histologic) descriptionCite this page: Sangle N. Tubulointerstitial nephritis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/kidneytubulointerstitialnephritis.html. 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
- 23 year old woman with tuberculosis (Clin Nephrol 2011;76:487)
- 42 year old man with rising serum creatinine 18 months after initiation of adalimumab therapy for ankylosing spondylitis (Am J Kidney Dis 2010;56:e17)
- 70 year old woman taking carbamazepine (Clin Exp Nephrol 2012;16:168)
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
