Causes of Chronic Tubulointerstitial Nephritis

Cause

Examples

Balkan nephropathy

Cystic diseases

Acquired cystic disease

Medullary cystic disease

Medullary sponge kidney

Nephronophthisis

Polycystic kidney disease*

Medications

Analgesics*

Chinese herbs (due to aristolochic acid†)

Granulomatous

Granulomatosis with polyangiitis

Inflammatory bowel disease

Sarcoidosis

Tuberculosis

Hematologic

Aplastic anemia

Leukemia

Lymphoma

Multiple myeloma*

Sickle cell anemia

Hereditary nephropathy associated with hyperuricemia and gout

Idiopathic

Immunologic

Amyloidosis

Cryoglobulinemia

Goodpasture syndrome

IgA nephropathy

Renal transplant rejection

Sarcoidosis

Sjögren syndrome

Systemic lupus erythematosus (SLE)

IgG4-related tubulointerstitial nephritis‡

Infection

Renal parenchymal:

Systemic

Mechanical

Obstructive uropathy

Reflux nephropathy*

Mesoamerican nephropathy§

––

Metabolic

Chronic hypokalemia

Cystinosis

Fabry disease

Hypercalcemia, hypercalciuria

Hyperoxaluria

Hyperuricemia*, hyperuricosuria

Radiation nephritis

Toxins

Aristolochic acid†

Heavy metals (eg, arsenic, bismuth, cadmium, chromium, copper, gold, iron, lead, mercury, uranium)

Vascular

Atheroembolism

Hypertension

Renal vein thrombosis

* Common causes.

† Contained in some medicinal herbs used in traditional Chinese medicine.

Yamaguchi Y, Kanetsuna Y, Honda K, et al: Characteristic tubulointerstitial nephritis in IgG4-related disease. Hum Pathol 43(4):536-549, 2012. doi: 10.1016/j.humpath.2011.06.002

§ Correa-Rotter R, Wesseling C, Johnson RJ: CKD of unknown origin in Central America: The case for Mesoamerican nephropathy. Am J Kidney Dis 63(3):506-520, 2014. doi: 10.1053/j.ajkd.2013.10.062