Renal tubulo-interstitial disorders

Last updated: Saturday, 29, January, 2011
CausesAppropriate Tests

Diagnosis guided by clinical context.

Biopsy may be required to establish underlying cause.

Baseline studies may include: electrolytes, creatinine, urea, calcium, phosphate, albumin; FBC.

Urine - microscopy. Urine acidification test only if significant renal tubular acidosis is suspected.

Water deprivation test if polyuria is clinically significant.

Renal biopsy if indicated.

Toxic

Analgesic nephropathy 

See Analgesic abuse

Other drugs, especially

  • Aminoglycosides
  • Amphotericin B
  • Cyclosporin
  • Lithium
  • Cis-platinum

 

Antibiotic (aminoglycoside) assay.

Cyclosporin levels
Lithium

Lead poisoning

Metabolic

Crystal nephropathy, especially 

  • Urate
  • Oxalate

Urine - microscopy.

See Gout
Oxalate - urine

Hypercalcaemia

Hypokalaemia

Drug hypersensitivity intertitial nephritis

Urine - microscopy (examination for eosinophils). Assay of immunoglobulin E is of no clinical value.

  • NSAID
  • Penicillin
  • Cephalosporins
  • Phenindione
  • Thiazides
  • Frusemide

Infection

Pyelonephritis, acute 

See Urinary tract infection

Tuberculosis

Leptospirosis

Other

Transplant rejection

Sjögren syndrome

Amyloidosis

Multiple myeloma

Medullary sponge kidney