Acquired Chronic Tubulointerstitial Nephritis

Abstract

Chronic acquired tubulointerstitial disease encompasses a heterogeneous collection of causes of kidney injury. Although there are a number of uncommon and/or regionally specific diagnoses which present in this category, there is also an inadequately defined and, as yet, poorly understood syndrome responsible for a substantial burden of kidney disease morbidity and mortality in low- and middle-income countries. Given the attributes of the renal tubule, chronic injury is most typically due to long-term exogenous toxin exposure, although metabolic, infectious and autoimmune causes are also well described. Chronic acquired tubulointerstitial disease typically presents without clear symptoms, and proteinuria, haematuria and hypertension are often absent, making identification challenging except through estimates of kidney function using serum biomarkers. Renal biopsy will demonstrate tubulointerstitial fibrosis, but the underlying cause is usually ascertained from the clinical history. Although specific therapy may be indicated in certain cases, reduction in exposure to environmental factors is likely to be the key intervention to reduce the impact of these diseases.