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8 out of 9

Which of the following is the least important finding in interstitial nephritis?

A Hypokalemia
B Hyperkalemia

C Hypertension
D Non anion gap metabolic acidosis

Ans. C Hypertension

Extra Edge:

Acute Interstitial Nephritis

i. Drugs are a leading cause of Acute Interstitial Nephritis

ii. It presents with acute oliguria and sometimes fever, rash and arthralgias

iii. In addition to azotemia, tubular dysfunction may be present

iv. Eosinophilia is common. Urine analysis shows eosinophiluria.(AIPG 06) and/or WBC casts.

v. On renal biopsy, interstitial edema with WBC infiltration is present.

vi. This disorder commonly responds to withdrawal of offending drug, and most patients have good recovery. Glucocorticoids may promote recovery.

Chronic Interstitial Nephritis

a. Analgesic nephropathy is an important cause of this disorder and results from prolonged consumption of a combination of analgesics, usually of phenacetin and aspirin.

b. Patients are often women with headaches, anemia, and GI symptoms.

c. Manifestation includes uremia, acute papillary necrosis, sterile pyuria, or renal calculi.

d. Renal function stabilizes with total cessation of drugs.

Functional Consequences of Tubulointerstitial Disease (Ref. H-17th Edi, P- 1807 Table 279-2)



Fanconi syndrome

Damage to proximal tubular reabsorption of glucose, amino acids, phosphate, and bicarbonate

Hyperchloremic acidosis

1. Reduced ammonia production

2. Inability to acidify the collecting duct fluid (distal renal tubular acidosis)

3. Proximal bicarbonate wasting

Tubular or small-molecular-weight proteinuria

Failure of proximal tubule protein reabsorption

Polyuria, isosthenuria

Damage to medullary tubules and vasculature


Potassium secretory defects including aldosterone resistance

Salt wasting

Distal tubular damage with impaired sodium reabsorption

Reduced GFR (Late feature)

Obliteration of microvasculature and obstruction of tubules

Treatment: Symptomatic