1. Tubuloiterstitial diseases

2. 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

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6. Tubuloiterstitial diseases
erythrocytes - are present in interstitial nephritis
erythrocyte casts
should really alarm of the possibility of a glomerular origin of the erythrocytes

7. Tubuloiterstitial diseases

8. 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

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beautiful draw of 1898
a round nuclear interstitial infiltrate with plasma cells and lymphocytes

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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

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the classic picture
normal glomeruli
in the interstitium
patchy infiltrate with
mostly lymphocytes, sometimes granulocytes, plasma cells

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a case of a very dense interstitial infiltrate

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interstitial infiltrate
large accumulations of protein visible in the tubules

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Interstitial hemmorages
a large number of erythrocytes in the peritubular capillaries and also outside of those capillaries

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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

20. 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

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global sclerosis

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anti-TBM nephritis
very rare
either or not in the context of SLE

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Differential diagnosis

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a common cause of tubulointerstitial nephritis

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a drug-induced hypersensitivity with a few eosinophils present
the absence of eosinophils does not exclude a drug-induced hypersensitivity(an important clinical effect)

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in the other causes of interstitial nephritis with don’t often see that high proteinuria

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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

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