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This article provides an overview of tubulointerstitial diseases, including their high incidence and diagnostic importance. It discusses the presence of erythrocytes in interstitial nephritis, the diagnostic value of eosinophiluria, and the limitations of renal biopsy for excluding glomerulonephritis. The article also covers the pathological features of tubulointerstitial diseases, such as interstitial infiltrates, protein accumulation, and interstitial hemorrhages. Chronic tubulointerstitial nephritis and its complications, such as interstitial fibrosis and global sclerosis, are also discussed. Additionally, the article mentions anti-TBM nephritis and highlights the differential diagnosis of drug-induced hypersensitivity reactions.
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Tubuloiterstitial diseases Incidence interstitial nephritis is: an important disease a highly incident disease within the domain of renal pathology its incidence is: almost twice that of glomerulonephritis almost twice that of diabetic nephropathy only nephrosclerosis has a higher incidence
Tubuloiterstitial diseases erythrocytes - are present in interstitial nephritis erythrocyte casts should really alarm of the possibility of a glomerular origin of the erythrocytes
Tubuloiterstitial diseases asking the question of the diagnostic value of eosinophiluria in patients with acute interstitial nephritis almost two times of them have eosinophiluria as those who have not in patients without acute interstitial nephritis the great majority don’t have eosinophiluria so there is some diagnostic value in this
Tubuloiterstitial diseases beautiful draw of 1898 a round nuclear interstitial infiltrate with plasma cells and lymphocytes
Tubuloiterstitial diseases question how large should the biopsy be in order to exclude glomerulonephritis the answer the biopsy is never enough to really exclude glomerulonephritis diagnosis is always a matter of clinical / pathological discussion any glomerular infiltration “transportation” of inflammation in interstitium
Tubuloiterstitial diseases the classic picture normal glomeruli in the interstitium patchy infiltrate with mostly lymphocytes, sometimes granulocytes, plasma cells
Tubuloiterstitial diseases a case of a very dense interstitial infiltrate
Tubuloiterstitial diseases interstitial infiltrate large accumulations of protein visible in the tubules
Tubuloiterstitial diseases Interstitial hemmorages a large number of erythrocytes in the peritubular capillaries and also outside of those capillaries
Tubuloiterstitial diseases the erythrocytes stemming from the inflamed glomerulus and finding their way down into the tubule forming the erythrocyte cast there if an erythrocyte cast exists - a glomerular disease is more likely
Tubuloiterstitial diseases Once the tubulointerstitial nephritis becomes chronic tubular atrophy interstitial fibrosis destruction of the basement membranes secondary glomerulosclerosis a typical slightly older lesion less interstitial infiltrate deposition of interstitial collagens between the tubules atrophic tubules -with a wrinkled tubular basement membrane
Tubuloiterstitial diseases global sclerosis
Tubuloiterstitial diseases anti-TBM nephritis very rare either or not in the context of SLE
Tubuloiterstitial diseases Differential diagnosis
Tubuloiterstitial diseases a common cause of tubulointerstitial nephritis
Tubuloiterstitial diseases a drug-induced hypersensitivity with a few eosinophils present the absence of eosinophils does not exclude a drug-induced hypersensitivity(an important clinical effect)
Tubuloiterstitial diseases in the other causes of interstitial nephritis with don’t often see that high proteinuria
Tubuloiterstitial diseases misunderstandings about TIN (of clinical importance) the onset should always be only 2-3 weeks after starting a new drug that’s not true - it can also occur many years after the start of the drug the fever, skin rash and eosinophilia should be imperative that’s not true - there can also be drug-induced hypersensitivity and TIN without any of these signs earlier usage of drugs without hypersensitivity symptoms should exclude the same drug as a cause of TIN but cases have been described showing the contrary
