Nephritis

Kidney diseases that involve structures in the kidney outside the glomerulus are broadly referred to as tubulointerstitial. These diseases generally involve tubules and/or the interstitium of the kidney and spare the glomeruli. Although primary glomerular diseases are often associated with prominent tubulointerstitial changes, the clinical presentation is dominated by the consequences of glomerular injury; hence, they are not considered in this article.

Tubulointerstitial diseases of the kidney encompass diverse etiologies and pathophysiologic processes, and the patient can present with acute or chronic conditions.

Many forms of tubulointerstitial injury involve exposure to drugs or other nephrotoxic agents such as heavy metals and, rarely, infection. By far the most common form of tubulointerstitial inflammation is immunologic.

Nephritis is inflammation of the kidneys. It may be caused by a bacterial infection of the kidneys (pyelonephritis) or exposure to a toxin. However, it more commonly develops from an abnormal immune reaction, which can occur in two ways:

1. An antibody can attack either the kidney itself or a substance that stimulates an immune reaction (antigen) attached to kidney cells, or
2. An antigen and antibody can combine somewhere else in the body, forming an immune complex, and then attach to cells in the kidney.

Some types of nephritis involve infiltration of kidney tissues by white blood cells and deposits of antibodies. In other types of nephritis, inflammation may consist of tissue swelling or scarring without white blood cells or antibodies. Nephritis can occur anywhere in the kidneys.

What are the symptoms of Nephritis

Less commonly, nephritis involves the tubules and the tissues that surround them (tubulointerstitial tissues). Such inflammation is called tubulointerstitial nephritis. A kidney tubule is a microscopic tube that carries fluid and substances filtered from the blood in the glomerulus to the duct that drains urine into the pelvis of the kidney. Tubulointerstitial tissues surround each of the tubules and separate one tubule from another.

When inflammation damages the tubules and the tubulointerstitial tissues, the kidneys may become unable to concentrate urine, eliminate (excrete) metabolic waste products from the body, or balance the excretion of sodium and other electrolytes, such as potassium. When the tubules and tubulointerstitial tissues are damaged, kidney failure often develops.

Prognosis of Nephritis

Prognosis for most cases of glomerulonephritis is generally good. Ninety percent of children recover without complications. With proper medical treatment, symptoms usually subside within a few weeks, or at the most, a few months.

Pyelonephritis in the acute form offers a good prognosis if diagnosed and treated early. Follow-up urinalysis studies will determine if the patient remains bacteria-free. If the infection is not cured or continues to recur, it can lead to serious complications such as bacteremia (bacterial invasion of the bloodstream), hypertension, chronic pyelonephritis and even permanent kidney damage.

Nephritis - Lupus Nephritis, Interstitial Nephritis, Analgesic Nephropathy

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