tubulointerstitial nephritis

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 [nĕ-fri´tis] (pl. nephri´tides)
inflammation of the kidney; a focal or diffuse proliferative or destructive disease that may involve the glomerulus, tubule, or interstitial renal tissue. Called also Bright's disease. The most usual form is glomerulonephritis, that is, inflammation of the glomeruli, which are clusters of renal capillaries. Damage to the membranes of the glomeruli results in impairment of the filtering process, so that blood and proteins such as albumin pass out into the urine. Depending on the symptoms it produces, nephritis is classified as acute nephritis, chronic nephritis, or nephrosis (called also the nephrotic syndrome).
Acute Nephritis. This occurs most frequently in children and young people and seems to strike those who have recently suffered from sore throat, scarlet fever, and other infections caused by streptococci; it is believed to originate as an immune response on the part of the kidney. An attack may produce no symptoms, but more often there are headaches, a rundown feeling, back pain, and perhaps slight fever. The urine may look smoky, bloody, or wine-colored. Analysis of the urine shows the presence of erythrocytes, albumin, and casts. Another symptom is edema of the face or ankles, more common in the morning than in the evening. The blood pressure usually rises during acute nephritis, and in severe cases hypertension may be accompanied by convulsions.

Treatment consists chiefly of bed rest and a carefully controlled diet. Penicillin is often used if an earlier streptococcal infection is still lingering. Recovery is usually complete. In a small percentage of cases, however, acute nephritis resists complete cure. It may subside for a time and then become active again, or it may develop into chronic nephritis. Dialysis may be indicated in patients with fluid overload that is refractory to diuretics, or who become clinically uremic.
Chronic Nephritis. Chronic nephritis may follow a case of acute nephritis immediately or it may develop after a long interval during which no symptoms have been present. Many cases of chronic nephritis occur in people who have never had the acute form of the disease. Symptoms are often unpredictable and variable from case to case, but there is almost always steady, progressive, permanent damage to the kidneys.

Chronic nephritis generally moves through three stages. In the first stage, the latent stage, there are few outward symptoms. There may be slight malaise, but often the only indication of the disease is the presence of albumin and other abnormal substances in the urine. If a blood count is made during this stage, anemia may be found. There is no special treatment during the latent stage of chronic nephritis. The patient can live a normal life but should avoid extremes of fatigue and exposure and should eat a well balanced diet.

The first stage may be followed by a second stage, in which edema occurs in the face, legs, or arms. The main treatment in this stage consists of a low-protein, low-sodium diet and diuretics. Steroid hormones may be helpful.

At the final stage of chronic nephritis is end-stage renal disease. Treatments are kidney transplant and dialysis. At any stage of chronic nephritis it is particularly important to avoid other infections, which will aggravate the condition.

There is no known cure for chronic nephritis, although the progress of the disease can be delayed, so that the patient can live an almost normal life for years. Many patients are being helped by repeated purification of their uremic blood by hemodialysis or peritoneal dialysis, or by transplantation.
glomerular nephritis glomerulonephritis.
interstitial nephritis nephritis with increase of interstitial tissue and thickening of vessel walls and malpighian corpuscles; it may be due to overuse of analgesics, mercury poisoning, gout, or any of various other conditions.
lupus nephritis glomerulonephritis associated with systemic lupus erythematosus.
potassium-losing nephritis see under nephropathy.
radiation nephritis kidney damage caused by ionizing radiation; symptoms include glomerular and tubular damage, hypertension, and proteinuria, sometimes leading to renal failure. It may be acute or chronic, and some varieties do not manifest until years after the radiation exposure.
salt-losing nephritis salt-losing nephropathy.
transfusion nephritis nephropathy following transfusion from an incompatible donor as a result of the hemoglobin of the hemolyzed red blood cells being deposited in the renal tubules.
tubulointerstitial nephritis nephritis of the renal tubules and interstitial tissues, usually seen secondary to a drug sensitization, systemic infection, graft rejection, or autoimmune disease. Characteristics include lymphocytes in interstitial infiltrate and within tubules, mild hematuria, and pyuria. Acute tubulointerstitial nephritis is usually seen as a complication of infection or allergy. Chronic tubulointerstitial nephritis is when the condition has progressed to interstitial fibrosis with shrunken kidneys, a lowered glomerular filtration rate, and danger of renal failure.

tu·bu·lo·in·ter·sti·tial ne·phri·tis

nephritis affecting renal tubules and interstitial tissue, with infiltration by plasma cells and mononuclear cells; seen in lupus nephritis, allograft rejection, and methicillin sensitization.

tu·bu·lo·in·ter·sti·tial ne·phri·tis

(tū'byū-lō-in-tĕr-stish'ăl nĕ-frī'tis)
Inflammation affecting renal tubules and interstitial tissue, with infiltration by plasma cells and mononuclear cells; seen in lupus nephritis, allograft rejection, and methicillin sensitization.


(ne-frit'is) (ne-frit'i-dez?) plural.nephritides [ nephr- + -itis]
Inflammation of the kidneys. The condition whether either acute or chronic is caused by bacteria or their toxins (e.g., pyelonephritis), autoimmune disorders (e.g., poststreptococcal glomerulonephritis, systemic lupus erythematosus), or toxic chemicals (e.g., pesticides, mercury, arsenic, lead, alcohol). The glomeruli, tubules, interstitial tissues, and renal pelvis may be affected.

Patient care

Renal function is assessed by measuring serum creatinine, blood urea nitrogen, and urine creatinine clearance levels. Signs of renal failure (oliguria, azotemia, acidosis) are reported. Hemoglobin, hematocrit, electrolyte levels, intake and output of fluids, and body weights are monitored. The health care provider observes, records, and reports hematuria and monitors blood pressure using the same cuff, arm, and position each time. Antihypertensive drugs are administered as prescribed. The patient is encouraged to maintain adequate hydration and follow the prescribed dietary restrictions, which may include limits on the amounts of sodium, potassium, fluid volume, and protein ingested. Intravenous fluid intake is monitored. Complications of hypertension are anticipated and prevented.

acute nephritis

An inflammatory nephritis involving the glomeruli, the tubules, or the entire kidney. It may be degenerative, diffuse, suppurative, hemorrhagic, interstitial, or parenchymal, depending upon the portion of the kidney involved.

analgesic nephritis

Analgesic nephropathy.

chronic nephritis

A progressive nephritis in which the entire structure of the kidney or only the glomerular or tubular processes may be affected.

glomerular nephritis


hereditary nephritis

Alport's syndrome.

interstitial nephritis

Nephritis associated with pathological changes in the renal interstitial tissue. The diseased tissue may be primary or due to a toxic agent such as a drug or chemical. Common findings include fever, rash, itch, and eosinophiles in the urine. The result is the destruction of the nephrons and serious impairment of renal function.

scarlatinal nephritis

Acute glomerulonephritis complicating scarlet fever.

suppurative nephritis

Nephritis associated with abscesses in the kidney.

transfusion nephritis

Renal failure and tubular disease caused by transfusion of incompatible blood.

tubal nephritis

An obsolete term for inflammation of kidney tubules.

tubulointerstitial nephritis

References in periodicals archive ?
Relapsing tubulointerstitial nephritis in an adolescent with inflammatory bowel disease without aminosalicylate exposure.
Granulomatous tubulointerstitial nephritis in the renal allograft.
3,4,10,19) We have also identified kidney disease that is unrelated to the tumor and only incidentally present at the time of nephrectomy, such as atheroembolic disease and granulomatous tubulointerstitial nephritis.
Diabetic nephropathy (a) 28 Hypertensive nephropathy 11 Focal segmental glomerulosclerosis (b) 7 Collapsing glomerulopathy (c) 2 Granulomatous tubulointerstitial nephritis (d) 2 Acute pyelonephritis 1 Thrombotic microangiopathy 1 Atheroembolic disease 1 Reflux nephropathy (e) 1 Proliferative glomerulonephritis (f) 1 Membranous glomerulonephritis (g) 1 Amyloidosis 1 (a) All patients had clinical diabetes.
Balkan endemic nephropathy, a familial form of chronic tubulointerstitial nephritis, is associated frequently with urothelial carcinoma of the upper urinary tract.
Nonneoplastic Changes in Nephrectomy Specimens Removed for Renal Neoplasms * Changes Percentage Normal 10 Vascular changes with normal parenchyma 29 Vascular changes with parenchymal scarring 22 Diabetic nephropathy 23 Others 8 Atheroembolism 2 Acute tubulointerstitial nephritis 2.
Tubulointerstitial Injury Due to Nonprescription Drugs Medicinal herbs, particularly those containing aristolochic acid, have known renal toxicity, resulting in a severe tubulointerstitial nephritis and urinary tract carcinomas.
Jaradat et al (83) reported 2 cases of acute renal failure related to a tubulointerstitial nephritis with giant cell formation associated with indinavir (Figure 9), demonstrating that asymptomatic crystalluria could be an indicator of more serious renal injury and warrants close monitoring of renal function.
By light microscopy (Figure 1, original magnification x100), the biopsy showed tubulointerstitial nephritis with a predominantly lymphocytic infiltrate.