emedicine.medscape.com Open in urlscan Pro
172.64.150.155 Public Scan

Back to summary

URL:
https://emedicine.medscape.com/article/243597-treatment
Submission: On April 19 via manual (April 19th 2024, 2:29:24 pm UTC) from US — Scanned from US

Form analysis
2 forms found in the DOM

Name: SearchFormHeader — GET javascript:subsearchheadertrack('en');

<form name="SearchFormHeader" class="search-form-header" method="get" aria-label="Search" action="javascript:subsearchheadertrack('en');">
  <input type="hidden" value="news" name="searchSrc">
  <input id="search-input" class="search-input search-input-text" aria-label="Search" type="text" autocomplete="off" autocorrect="off" name="q" maxlength="500" placeholder="Search">
  <button type="submit" class="search-submit-button" aria-label="Search" title="search">
    <svg xmlns="https://www.w3.org/2000/svg" viewBox="0 0 21 21">
      <path fill="#005B80" fill-rule="evenodd"
        d="M12.018 12.468c-2.155 2.156-5.63 2.156-7.784 0-2.155-2.154-2.155-5.63 0-7.784 2.154-2.155 5.63-2.155 7.784 0 2.155 2.155 2.133 5.63 0 7.784M2.54 2.99c-3.078 3.08-3.078 8.07 0 11.15 2.727 2.727 6.927 3.035 10.006.946l5.168 5.167c.572.572 1.517.572 2.09 0 .57-.572.57-1.517 0-2.09l-5.17-5.166c2.09-3.08 1.782-7.28-.945-10.006-3.08-3.077-8.07-3.077-11.15 0">
      </path>
    </svg></button>
  <button type="button" class="search-open-button js-expand-button" data-section=".header-search" aria-label="Search">
    <svg xmlns="https://www.w3.org/2000/svg" viewBox="0 0 21 21">
      <path fill="#005B80" fill-rule="evenodd"
        d="M12.018 12.468c-2.155 2.156-5.63 2.156-7.784 0-2.155-2.154-2.155-5.63 0-7.784 2.154-2.155 5.63-2.155 7.784 0 2.155 2.155 2.133 5.63 0 7.784M2.54 2.99c-3.078 3.08-3.078 8.07 0 11.15 2.727 2.727 6.927 3.035 10.006.946l5.168 5.167c.572.572 1.517.572 2.09 0 .57-.572.57-1.517 0-2.09l-5.17-5.166c2.09-3.08 1.782-7.28-.945-10.006-3.08-3.077-8.07-3.077-11.15 0">
      </path>
    </svg></button>
  <div class="ilfulllist">
    <p class="il_combo_nor">No Results</p>
    <ul class="combolist"></ul>
  </div>
</form>

Name: SearchFormHeader — GET javascript:subsearchheadertrack('en');

<form name="SearchFormHeader" class="search-form-header" method="get" aria-label="Search" action="javascript:subsearchheadertrack('en');">
  <input type="hidden" value="news" name="searchSrc">
  <input id="layer-search-input" class="search-input search-input-text" aria-label="Search" type="text" autocomplete="off" autocorrect="off" name="q" maxlength="500" placeholder="Search">
  <button type="submit" class="search-submit-button" aria-label="Search" title="search">
    <svg xmlns="https://www.w3.org/2000/svg" viewBox="0 0 21 21">
      <path fill="#005B80" fill-rule="evenodd"
        d="M12.018 12.468c-2.155 2.156-5.63 2.156-7.784 0-2.155-2.154-2.155-5.63 0-7.784 2.154-2.155 5.63-2.155 7.784 0 2.155 2.155 2.133 5.63 0 7.784M2.54 2.99c-3.078 3.08-3.078 8.07 0 11.15 2.727 2.727 6.927 3.035 10.006.946l5.168 5.167c.572.572 1.517.572 2.09 0 .57-.572.57-1.517 0-2.09l-5.17-5.166c2.09-3.08 1.782-7.28-.945-10.006-3.08-3.077-8.07-3.077-11.15 0">
      </path>
    </svg></button>
  <div class="ilfulllist">
    <p class="il_combo_nor">No Results</p>
    <ul class="combolist"></ul>
  </div>
</form>

Text Content

News & Perspective
Drugs & Diseases
CME & Education
Video
Decision Point
Edition: English

Medscape

English
Deutsch
Español
Français
Português
UKNew

Univadis

Français New
Italiano New
Log In
Sign Up It's Free!
English Edition

Medscape

* English
* Deutsch
* Español
* Français
* Português
* UKNew

Univadis

* Français New
* Italiano New

X
Univadis from Medscape

No Results

News & Perspective Drugs & Diseases CME & Education Video Decision Point

close
Please confirm that you would like to log out of Medscape. If you log out, you
will be required to enter your username and password the next time you visit.
Log out Cancel

https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMjQzNTk3LXRyZWF0bWVudA==

processing....

Drugs & Diseases > Nephrology

TUBULOINTERSTITIAL NEPHRITIS TREATMENT & MANAGEMENT

Updated: Mar 28, 2024
* Author: A Brent Alper, Jr, MD, MPH; Chief Editor: Vecihi Batuman, MD, FASN
more...

* 15
* Share
* Print
* Feedback

Close
* Facebook
* Twitter
* LinkedIn
* WhatsApp
* Email

Sections
Tubulointerstitial Nephritis

* Sections Tubulointerstitial Nephritis
* Overview

* Practice Essentials
* Pathophysiology
* Etiology
* Epidemiology
* Prognosis
* Show All
* Presentation
* DDx
* Workup

* Approach Considerations
* CBC with Differential
* Chemistry Panel
* Urine Studies
* Ultrasonography and Radiography
* CT Scanning
* EDTA Lead Mobilization Test
* Kidney Biopsy and Histologic Features
* Show All
* Treatment

* Approach Considerations
* Management of Acute Tubulointerstitial Nephritis
* Management of Chronic Tubulointerstitial Disease
* Show All
* Medication

* Medication Summary
* Glucocorticoids
* Chelating agents
* Show All
* Questions & Answers
* Media Gallery
* References

Treatment

APPROACH CONSIDERATIONS

Corticosteroids have been a mainstay of therapy for tubulointerstitial
nephritis, but mycophenolate mofetil may also have a role. Ultimately, however,
treatment depends on the underlying etiology. [2] In IgG4-related cases,
rituximab is used as second-line therapy and for maintenance. [35]

Most patients presenting with kidney insufficiency, proteinuria, and/or
acid-base electrolyte disorders require consultation with a nephrologist. These
patients may require inpatient care until stabilization or resolution.

Hypertensive patients should be on a low-sodium diet. For all patients with
early renal disease, recommend general guidelines for a healthy diet (ie,
low-fat [low-cholesterol] diet rich in fresh fruits and vegetables such as the
Dietary Approaches to Stop Hypertension [DASH] diet).

Provide patients with acute interstitial nephritis with follow-up care until
resolution. Patients who do not recover kidney function and those with chronic
tubulointerstitial nephritis should receive long-term follow-up care to ensure
that optimal control of blood pressure is achieved and to protect kidneys from
further potentially nephrotoxic therapies and/or interventions.

Next: Management of Acute Tubulointerstitial Nephritis

MANAGEMENT OF ACUTE TUBULOINTERSTITIAL NEPHRITIS

In cases of acute tubulointerstitial nephritis due to hypersensitivity reactions
(allergic interstitial nephritis), early recognition and prompt discontinuation
of the offending drug are helpful; cessation of the offending agent usually, but
not always, results in complete recovery in patients. However, the rate of
recovery is variable, and, in some patients, renal failure persists for many
weeks before renal function improves. Some patients may progress to chronic
renal insufficiency.

Obtain a thorough history of previously documented drug allergies before
prescribing a new drug.

If no sign of improvement is observed within a few days of discontinuation of
the offending agent, consider therapy with steroids. Although controlled trials
are lacking, many authors suggest using prednisone at relatively high doses (eg,
1 mg/kg for 4-6 wks with rapid tapering of the dose). This intervention may
improve the outcome, speeding renal recovery and reducing the requirement for
dialysis.

A systematic review concluded that limited evidence does not support the use of
corticosteroids in the treatment of drug-induced cases. The review included
eight studies with 430 patients (300 of whom received corticosteroids and 130 of
whom did not): four studies showed no difference in serum creatinine levels
between the corticosteroid and comparator arms, while four studies found a
benefit. [36]

Previous
Next: Management of Acute Tubulointerstitial Nephritis

MANAGEMENT OF CHRONIC TUBULOINTERSTITIAL DISEASE

Treatment of chronic tubulointerstitial nephritis depends on the etiology and
generally consists of supportive measures, such as adequate blood pressure
control and management of anemia.

ANALGESIC NEPHROPATHY

Treatment of analgesic nephropathy is supportive and also includes
discontinuation of analgesic use. Long-term follow-up studies have shown
progression to end-stage renal disease (ESRD) requiring dialysis, and increased
incidence of uroepithelial cancers is also observed in patients with analgesic
nephropathy.

CYCLOSPORINE/TACROLIMUS–INDUCED ACUTE KIDNEY INJURY

Reduce the cyclosporine/tacrolimus doses and target trough levels. Discontinuing
these medications and/or switching to other immunosuppressives (eg, rapamycin),
especially in those with more advanced renal failure, should also be considered.

LEAD NEPHROPATHY

Body burden of lead and bone lead concentration can be reduced by extended
chelation treatment using ethylenediaminetetraacetic acid (EDTA) (versenate).
Chelation therapy is of proven value and must be implemented in acute lead
poisoning. Although the oral chelating agent succimer (Chemet) has proved highly
successful in treating children, it has not been widely used in adults.
Nevertheless, it appears effective in reducing body lead stores.

Chelation therapy with EDTA may slow progressive renal insufficiency in patients
with mild lead intoxication. Several studies from Taiwan have shown that
chelation therapy in patients with modest increases in body lead burden (ie,
80-600 µg of lead) significantly slowed and/or reversed the rate of decline in
the glomerular filtration rate (GFR) compared with placebo. [37, 38] This was
found in both diabetics and nondiabetics. [37, 38] However, given that these
studies took place in Taiwan, it is difficult to generalize these results.
Further study is needed before this treatment can be recommended.

Because no effective therapy reverses the long-term consequences of lead
poisoning, the best therapy is prevention and awareness of potential
environmental and occupational sources for lead exposure. Therefore, implement
environmental measures, such as removal of lead from indoor paint and gasoline,
and eliminate other sources of exposure. Use caution with imported ceramics,
particularly if glazed.

In patients with established lead nephropathy, treatment consists of management
of hypertension, gout, and chronic renal insufficiency. Many patients with lead
nephropathy progress to end-stage kidney failure and require dialysis.

ATHEROSCLEROTIC KIDNEY DISEASE AND CHOLESTEROL MICROEMBOLIC DISEASE

No specific therapy is available for atherosclerotic kidney disease, but good
control of hypertension, cessation of smoking, and vigorous control of
dyslipidemia with diet and with statins are expected to result in improved
outcomes. There is also no effective treatment available for cholesterol
microembolic disease.

IMMUNOGLOBULIN G (IGG)-4–RELATED DISEASE

Corticosteroids in moderate to high doses are recommended for treatment of
IgG4-related kidney disease, and may result in some recovery of kidney function.
[23, 35] When steroids are contraindicated or ineffective, rituximab may be
used. [39] Rituximab has also been used for maintenance therapy in these
patients. [35]

Medication

REFERENCES

1. Bhandari J, Thada PK, Rout P, Arif H. Tubulointerstitial Nephritis. 2024
Jan. [QxMD MEDLINE Link]. [Full Text].

2. Joyce E, Glasner P, Ranganathan S, Swiatecka-Urban A. Tubulointerstitial
nephritis: diagnosis, treatment, and monitoring. Pediatr Nephrol. 2017 Apr.
32 (4):577-587. [QxMD MEDLINE Link]. [Full Text].

3. Harris RC, Neilson EG. Toward a unified theory of renal progression. Annu
Rev Med. 2006. 57:365-80. [QxMD MEDLINE Link].

4. Liu Y. Renal fibrosis: new insights into the pathogenesis and therapeutics.
Kidney Int. 2006 Jan. 69(2):213-7. [QxMD MEDLINE Link]. [Full Text].

5. Lidberg KA, Muthusamy S, Adil M, Mahadeo A, Yang J, Patel RS, et al. Serum
Protein Exposure Activates a Core Regulatory Program Driving Human Proximal
Tubule Injury. J Am Soc Nephrol. 2022 May. 33 (5):949-965. [QxMD MEDLINE
Link]. [Full Text].

6. Rangan GK, Wang Y, Tay YC, Harris DC. Inhibition of nuclear factor-kappaB
activation reduces cortical tubulointerstitial injury in proteinuric rats.
Kidney Int. 1999 Jul. 56(1):118-34. [QxMD MEDLINE Link].

7. Hadded S, Harzallah A, Chargui S, Hajji M, Kaaroud H, Goucha R, et al.
[Etiologies and prognostic factors of acute interstitial nephritis].
Nephrol Ther. 2021 Apr. 17 (2):114-119. [QxMD MEDLINE Link].

8. Martínez-Valenzuela L, Draibe J, Fulladosa X, Gomà M, Gómez F, Antón P, et
al. Acute Tubulointerstitial Nephritis in Clinical Oncology: A
Comprehensive Review. Int J Mol Sci. 2021 Feb 26. 22 (5):[QxMD MEDLINE
Link]. [Full Text].

9. Zhou P, Gao Y, Kong Z, Wang J, Si S, Han W, et al. Immune checkpoint
inhibitors and acute kidney injury. Front Immunol. 2024. 15:1353339. [QxMD
MEDLINE Link]. [Full Text].

10. Nakaoka S, Tsubata S, Adachi Y. Acute Tubulointerstitial Nephritis due to
Human Papillomavirus Vaccination. JMA J. 2024 Jan 15. 7 (1):130-132. [QxMD
MEDLINE Link]. [Full Text].

11. Wang Y, Yang L, Xu G. New-Onset Acute Interstitial Nephritis
Post-SARS-CoV-2 Infection and COVID-19 Vaccination: A Panoramic Review. J
Epidemiol Glob Health. 2023 Dec. 13 (4):615-636. [QxMD MEDLINE Link]. [Full
Text].

12. De Broe ME, Elseviers MM. Over-the-counter analgesic use. J Am Soc Nephrol.
2009 May 7. [QxMD MEDLINE Link].

13. Muhammad A, Xiao Z, Lin W, Zhang Y, Meng T, Ning J, et al. Acute
interstitial nephritis caused by ANCA-associated vasculitis: a case based
review. Clin Rheumatol. 2024 Mar. 43 (3):1227-1244. [QxMD MEDLINE Link].

14. Kmochová T, Kidd KO, Orr A, et al. Autosomal dominant ApoA4 mutations
present as tubulointerstitial kidney disease with medullary amyloidosis.
Kidney Int. 2024 Apr. 105 (4):799-811. [QxMD MEDLINE Link].

15. De Broe ME. Chinese herbs nephropathy and Balkan endemic nephropathy:
toward a single entity, aristolochic acid nephropathy. Kidney Int. 2012
Mar. 81(6):513-5. [QxMD MEDLINE Link].

16. Jelaković B, Dika Ž, Arlt VM, Stiborova M, Pavlović NM, Nikolić J, et al.
Balkan Endemic Nephropathy and the Causative Role of Aristolochic Acid.
Semin Nephrol. 2019 May. 39 (3):284-296. [QxMD MEDLINE Link]. [Full Text].

17. Maripuri S, Grande JP, Osborn TG, et al. Renal involvement in primary
Sjögren''s syndrome: a clinicopathologic study. Clin J Am Soc Nephrol. 2009
Sep. 4(9):1423-31. [QxMD MEDLINE Link]. [Full Text].

18. Jain A, Srinivas BH, Emmanuel D, Jain VK, Parameshwaran S, Negi VS. Renal
involvement in primary Sjogren's syndrome: a prospective cohort study.
Rheumatol Int. 2018 Aug 23. [QxMD MEDLINE Link].

19. Slade N, Moll UM, Brdar B, et al. p53 mutations as fingerprints for
aristolochic acid: an environmental carcinogen in endemic (Balkan)
nephropathy. Mutat Res. 2009 Apr 26. 663(1-2):1-6. [QxMD MEDLINE Link].
[Full Text].

20. Salvadori M, Tsalouchos A. Immunoglobulin G4-related kidney diseases: An
updated review. World J Nephrol. 2018 Jan 6. 7 (1):29-40. [QxMD MEDLINE
Link]. [Full Text].

21. Mbengue M, Goumri N, Niang A. IgG4-related kidney disease: Pathogenesis,
diagnosis, and treatment. Clin Nephrol. 2021 Jun. 95 (6):292-302. [QxMD
MEDLINE Link].

22. Gilani SI, Buglioni A, Cornell LD. IgG4-related kidney disease:
Clinicopathologic features, differential diagnosis, and mimics. Semin Diagn
Pathol. 2024 Mar. 41 (2):88-94. [QxMD MEDLINE Link].

23. Khosroshahi A, et al; Second International Symposium on IgG4-Related
Disease. International Consensus Guidance Statement on the Management and
Treatment of IgG4-Related Disease. Arthritis Rheumatol. 2015 Jul. 67
(7):1688-99. [QxMD MEDLINE Link]. [Full Text].

24. Saeki T, Nishi S, Imai N, Ito T, Yamazaki H, Kawano M, et al.
Clinicopathological characteristics of patients with IgG4-related
tubulointerstitial nephritis. Kidney Int. 2010 Nov. 78(10):1016-23. [QxMD
MEDLINE Link].

25. Mackensen F, Billing H. Tubulointerstitial nephritis and uveitis syndrome.
Curr Opin Ophthalmol. 2009 Sep 11. [QxMD MEDLINE Link].

26. Patel S, Hossain MA, Ajam F, Patel M, Nakrani M, Patel J, et al.
Dabigatran-Induced Acute Interstitial Nephritis: An Important Complication
of Newer Oral Anticoagulation Agents. J Clin Med Res. 2018 Oct. 10
(10):791-794. [QxMD MEDLINE Link]. [Full Text].

27. Roy S, Awogbemi T, Holt RCL. Acute tubulointerstitial nephritis in
children- a retrospective case series in a UK tertiary paediatric centre.
BMC Nephrol. 2020 Jan 14. 21 (1):17. [QxMD MEDLINE Link]. [Full Text].

28. Regusci A, Lava SAG, Milani GP, Bianchetti MG, Simonetti GD, Vanoni F.
Tubulointerstitial nephritis and uveitis syndrome: a systematic review.
Nephrol Dial Transplant. 2022 Apr 25. 37 (5):876-886. [QxMD MEDLINE Link].

29. Kanno H, Ishida K, Yamada W, Shiraki I, Murase H, Yamagishi Y, et al.
Clinical and Genetic Features of Tubulointerstitial Nephritis and Uveitis
Syndrome with Long-Term Follow-Up. J Ophthalmol. 2018. 2018:4586532. [QxMD
MEDLINE Link]. [Full Text].

30. Border WA, Holbrook JH, Peterson MC. Gallium citrate Ga 67 scanning in
acute renal failure. West J Med. 1995 May. 162(5):477-8. [QxMD MEDLINE
Link].

31. Linton AL, Richmond JM, Clark WF, Lindsay RM, Driedger AA, Lamki LM.
Gallium67 scintigraphy in the diagnosis of acute renal disease. Clin
Nephrol. 1985 Aug. 24(2):84-7. [QxMD MEDLINE Link].

32. Hettinga YM, Scheerlinck LM, Lilien MR, Rothova A, de Boer JH. The value of
measuring urinary β2-microglobulin and serum creatinine for detecting
tubulointerstitial nephritis and uveitis syndrome in young patients with
uveitis. JAMA Ophthalmol. 2015 Feb. 133 (2):140-5. [QxMD MEDLINE Link].

33. Shi Y, Su T, Qu L, Wang C, Li X, Yang L. Evaluation of urinary biomarkers
for the prognosis of drug-associated chronic tubulointerstitial nephritis.
Am J Med Sci. 2013 Oct. 346(4):283-8. [QxMD MEDLINE Link].

34. Saeki T, Kawano M, Nagasawa T, Ubara Y, Taniguchi Y, Yanagita M, et al.
Validation of the diagnostic criteria for IgG4-related kidney disease
(IgG4-RKD) 2011, and proposal of a new 2020 version. Clin Exp Nephrol. 2021
Feb. 25 (2):99-109. [QxMD MEDLINE Link]. [Full Text].

35. Chellappan A, Bhawane A, Sharma A, Rokade R. IgG4-Related Kidney Disease: A
Diagnostic Conundrum Successfully Treated With Steroids and Rituximab.
Cureus. 2024 Jan. 16 (1):e52000. [QxMD MEDLINE Link]. [Full Text].

36. Quinto LR, Sukkar L, Gallagher M. The effectiveness of corticosteroid
compared to non-corticosteroid therapy for the treatment of drug-induced
acute interstitial nephritis: A systematic review. Intern Med J. 2018 Aug
21. [QxMD MEDLINE Link].

37. Lin JL, Lin-Tan DT, Hsu KH, Yu CC. Environmental lead exposure and
progression of chronic renal diseases in patients without diabetes. N Engl
J Med. 2003 Jan 23. 348(4):277-86. [QxMD MEDLINE Link].

38. Lin JL, Lin-Tan DT, Yu CC, Li YJ, Huang YY, Li KL. Environmental exposure
to lead and progressive diabetic nephropathy in patients with type II
diabetes. Kidney Int. 2006 Jun. 69(11):2049-56. [QxMD MEDLINE Link].

39. McMahon BA, Novick T, Scheel PJ, Bagnasco S, Atta MG. Rituximab for the
Treatment of IgG4-Related Tubulointerstitial Nephritis: Case Report and
Review of the Literature. Medicine (Baltimore). 2015 Aug. 94 (32):e1366.
[QxMD MEDLINE Link]. [Full Text].

40. Inoue D, Yoshida K, Yoneda N, Ozaki K, Matsubara T, Nagai K, et al.
IgG4-related disease: dataset of 235 consecutive patients. Medicine
(Baltimore). 2015 Apr. 94 (15):e680. [QxMD MEDLINE Link]. [Full Text].

Media Gallery

* Tubulointerstitial nephritis: Kidney biopsy reveals acute interstitial
nephritis. The renal cortex shows a diffuse interstitial, predominantly
mononuclear, inflammatory infiltrate with no changes to the glomerulus.
Tubules in the center of the field are separated by inflammation and edema,
as compared with the more normal architecture in the right lower area
(periodic acid–Schiff, 40 X).

* Tubulointerstitial nephritis. On a kidney biopsy, the diagnosis of acute
interstitial nephritis is based on the active inflammatory infiltrate on the
right with unaffected glomeruli. Interstitial edema and fibrosis are present
on the left side of the field, where some tubules show thickened basement
membrane (hematoxylin and eosin, 20 X).

* Tubulointerstitial nephritis. Kidney biopsy shows acute interstitial
nephritis. The interstitium is expanded by mononuclear inflammatory
infiltrate and edema. Acute tubular damage is present; some tubules are
distended and contain granular casts (hematoxylin and eosin, 40 X).

* Tubulointerstitial nephritis. Kidney biopsy shows acute crescentic
glomerulonephritis. The glomerular tuft is compressed by the proliferation of
epithelial cells, forming a crescent. In addition, the interstitium shows
mononuclear inflammatory infiltrate and edema (periodic acid–Schiff, 40 X).

* Tubulointerstitial nephritis. Kidney biopsy shows acute interstitial
nephritis. The mononuclear inflammatory infiltrate contains abundant
eosinophils, suggesting an allergic etiology. Severe tubular damage is
observed (hematoxylin and eosin, 40 X).

* Tubulointerstitial nephritis. Kidney biopsy shows acute interstitial
nephritis. The inflammatory infiltrate forms an ill-defined granuloma,
suggesting allergic or infectious etiologies. A partially destroyed tubule is
present (periodic acid–Schiff, 40 X).

* Tubulointerstitial nephritis. Kidney biopsy shows chronic tubulointerstitial
nephritis. The interstitium is expanded by fibrosis, with distortion of
tubules and periglomerular fibrosis. Glomeruli do not show pathologic changes
(hematoxylin and eosin, 20 X).

* Tubulointerstitial nephritis. Kidney biopsy in interstitial nephritis shows a
cholesterol microembolism. The 2 arterioles in the center are occluded by
elongated crystals (hematoxylin and eosin, 20 X).

* Tubulointerstitial nephritis. Kidney biopsy in interstitial nephritis shows a
cholesterol microembolism. The arteriole in the center of the field has a
thickened wall. The lumen is occluded by elongated spaces, corresponding to
dissolved crystals surrounded by cellular reaction. The 2 glomeruli flanking
the arteriole are sclerotic and hardly recognizable (hematoxylin and eosin,
40 X).

of 9

TABLES

Back to List

CONTRIBUTOR INFORMATION AND DISCLOSURES

Author

A Brent Alper, Jr, MD, MPH Associate Professor of Medicine, Section of
Nephrology and Hypertension, Department of Medicine, Tulane University School of
Medicine

A Brent Alper, Jr, MD, MPH is a member of the following medical societies: Alpha
Omega Alpha, American College of Physicians, American Society of Hypertension,
American Society of Nephrology, National Kidney Foundation, Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of
Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug
Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Ajay K Singh, MB, MRCP, MBA Associate Professor of Medicine, Harvard Medical
School; Director of Dialysis, Renal Division, Brigham and Women's Hospital;
Director, Brigham/Falkner Dialysis Unit, Faulkner Hospital

Disclosure: Nothing to disclose.

Chief Editor

Vecihi Batuman, MD, FASN Professor of Medicine, Section of
Nephrology-Hypertension, Deming Department of Medicine, Tulane University School
of Medicine

Vecihi Batuman, MD, FASN is a member of the following medical societies:
American College of Physicians, American Society of Hypertension, American
Society of Nephrology, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Additional Contributors

F John Gennari, MD Associate Chair for Academic Affairs, Robert F and Genevieve
B Patrick Professor, Department of Medicine, University of Vermont College of
Medicine

F John Gennari, MD is a member of the following medical societies: Alpha Omega
Alpha, American College of Physicians-American Society of Internal Medicine,
American Federation for Medical Research, American Heart Association, American
Physiological Society, American Society for Clinical Investigation, American
Society of Nephrology, International Society of Nephrology

Disclosure: Nothing to disclose.

Acknowledgements

We wish to thank Suzanne Meleg-Smith, MD, for her previous contributions to this
article.

WHAT WOULD YOU LIKE TO PRINT?

What would you like to print?
* Print this section
* Print the entire contents of
* Print the entire contents of article

TOP PICKS FOR YOU

encoded search term (Tubulointerstitial Nephritis) and Tubulointerstitial
Nephritis
What to Read Next on Medscape
Related Conditions and Diseases
* Chronic Kidney Disease (CKD)
* Kidney Disease and Pregnancy
* Chronic Kidney Disease in Children
* Managing Cardiovascular Risk in Patients With Chronic Kidney Disease
* Fast Five Quiz: Chronic Kidney Disease Differential Diagnosis
* Fast Five Quiz: Chronic Kidney Disease Complications

News & Perspective
* Kids Who Are Overweight at Risk for Chronic Kidney Disease
* Transplantation, But Not Dialysis, Slows Biological Aging in Chronic Kidney
Disease
* Gestational Diabetes May Double Chronic Kidney Disease Risk
* AJKD Blog NephMadness
* Managing CKD in Primary Care: Latest Guidelines
* Immunoglobulin A Nephropathy: 5 Things to Know

Tools
* Drug Interaction Checker
* Pill Identifier
* Calculators
* Formulary

Slideshow
15 Fingernail and Toenail Abnormalities

Recommended
* 2010/recap/999500
Early Recognition of Chronic Kidney Disease in Patients With Type 2 Diabetes
* 2003/viewarticle/993337Clinical Review
Newer Therapies to Optimize Outcomes in Patients with Chronic Kidney Disease
1.25 CE Credits Clinical Review
You are being redirected to Medscape Education
Yes, take me there
1.25 CE
Newer Therapies to Optimize Outcomes in Patients with Chronic Kidney Disease

* 2002238798-overviewDiseases & Conditions
Diseases & Conditions Chronic Kidney Disease (CKD)

* Sections Tubulointerstitial Nephritis
* Overview

* Practice Essentials
* Pathophysiology
* Etiology
* Epidemiology
* Prognosis
* Show All
* Presentation
* DDx
* Workup

* Approach Considerations
* Management of Acute Tubulointerstitial Nephritis
* Management of Chronic Tubulointerstitial Disease
* Show All
* Medication

* Medication Summary
* Glucocorticoids
* Chelating agents
* Show All
* Questions & Answers
* Media Gallery
* References

Find Us On
About
About Medscape Privacy Policy Editorial Policy Cookies Manage Preferences Terms
of Use Advertising Policy Help Center
Membership
Become a Member About You Professional Information Newsletters & Alerts
Advertise Market Research
App
Medscape
WebMD Network
Medscape Live Events WebMD MedicineNet eMedicineHealth RxList WebMD Corporate
Medscape UK
Editions
English Deutsch Español Français Português UK
All material on this website is protected by copyright, Copyright © 1994-2024 by
WebMD LLC. This website also contains material copyrighted by 3rd parties.
Close

HEAR FROM HER: THE WOMEN IN HEALTHCARE LEADERSHIP SERIES

Episode 2 out now: The Power Dynamics of Women and Cancer

Listen Now - Ep 2

emedicine.medscape.com Open in urlscan Pro 172.64.150.155 Public Scan

Form analysis 2 forms found in the DOM

Name: SearchFormHeader — GET javascript:subsearchheadertrack('en');

Name: SearchFormHeader — GET javascript:subsearchheadertrack('en');

Text Content

emedicine.medscape.com Open in urlscan Pro
172.64.150.155 Public Scan

Form analysis
2 forms found in the DOM