Friday, 12 November 2010

MRCP revision battle 47.4: Chronic interstitial nephritis

Chronic interstitial nephritis/tubulointerstitial nephritis can be caused by many conditions and results in fibrosis and tubular loss which manifests clinically as chronic renal failure

Analgesic nephropathy

Analgesic nephropathy is associated with long-term use of NSAIDs, and to a lesser degree paracetamol.

It may present as:
  • sterile pyuria
  • chronic renal failure
  • renal pain (due to papillary necrosis)

An IVU will show 'cup and spill' calyces
Renal biopsy may show interstitial nephritis

Treatment is to stop the analgesics and managed any renal failure.

There is an increased risk of urothelial tumours.

Reflux Nephropathy

Reflux nephropathy is defined as small and irregularly scarred kidneys associated with vesico-ureteric reflux.

Almost always only occurs in first 5 yrs of life.

Associated with an increased risk of renal stones.

Balkan Nephropathy

Balkan nephropathy is a chronic interstitial renal disease found in a distribution along the River Danube.

It is associated with coppery yellow pigmentation of palms and soles.
There is raised beta 2 microglobinuria.

Urothelial malignancy is much increased - up to 200x risk.

Now on to Alport's syndrome...