Renal tubulo-interstitial disorders

Causes

Appropriate Tests

 

Diagnosis guided by clinical context.

Biopsy may be required to establish underlying cause.

Baseline studies may include: Electrolytes, Creatinine, Urea, Calcium, Phosphate, Albumin, Full blood count.

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 assay (aminoglycoside).
Cyclosporin levels
Lithium

Lead poisoning

 

Metabolic

 

Crystal nephropathy, especially

  • Urate
  • Oxalate

Urine - microscopy.

See Gout

Oxalate urine

Hypercalcaemia

 

Hypokalaemia

 

Drug hypersensitivity interstitial 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

 

Plasma cell myeloma

 

Medullary sponge kidney