0521779407-20 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:22
Tubulointerstitial Renal Disease 1467
magnitude and duration of back pressure determine severity
of chronic TIN
➣Hematopoietic disease
Sickle cell disease and trait – may cause papillary necrosis
Plasma Cell Dyscrasias
Lymphoproliferative disease (non-Hodgkin’s lymphoma and
lymphoblastic leukemia)
➣Heavy Metals
Lead (hyperuricemia, hypertension)
Cadmium
Mercury
Uranium
Arsenic
➣Metabolic Disease
Hypercalcemia
Hyperuricemia
Hyperoxaluria
Cystinosis
Chronic hypokalemia
➣Hereditary Disease
Polycystic kidney disease
Alport’s syndrome
Medullary sponge kidney
Hereditary nephritis
➣Granulomatous Disease
Sarcoidosis
Tuberculosis
Wegener’s
Heroin nephropathy
➣Others
Radiation
Hypertensive nephrosclerosis
Balkan nephropathy
➣Idiopathic
no definite etiology for 15–20% of cases of biopsy-proven
chronic TINmanagement
What to Do First
■obtain detailed history and physical exam
■assess severity of renal dysfunction
■what is rate of rise of serum creatinine (days, weeks, months, years)