Skip to Main Content


Tubulointerstitial diseases are a group of renal disorders characterized by primary abnormalities in the renal tubules or interstitium. There are four principal causes: infectious, toxic, metabolic, and immunologic.


The morphologic changes in tubulointerstitial disease include the following.


  1. Acute tubular necrosis (Table 49-1), which if widespread causes acute renal failure. The changes in all causes of acute tubular necrosis are similar and are discussed under renal changes associated with shock.

  2. Atrophy of tubules, with fibrosis of the interstitium, associated with nephron loss and chronic renal failure.

  3. Interstitial inflammation, either acute, with numerous neutrophils in the tubules and interstitium (acute interstitial nephritis); or chronic, with lymphocytes, plasma cells, macrophages, and fibroblasts (chronic interstitial nephritis).

  4. Tubular basement membrane thickening, as occurs in diabetes, amyloidosis, and transplant rejection.

  5. Deposition of abnormal substances such as calcium, amyloid, urate, myeloma proteins, and oxalate in the tubules and interstitium.

Table Graphic Jump Location
Table 49–1. Causes of Acute Tubular Necrosis.

Infectious Diseases


Acute Pyelonephritis


Acute pyelonephritis is extremely common—1more so in females than in males (10:1). Acute pyelonephritis occurs at all ages, with highest frequency during early sexual activity and during pregnancy.


Acute pyelonephritis is a bacterial infection, usually ascending from the lower urinary tract. Ascent of infection from the bladder is facilitated when vesicoureteral reflux is present. This is more important in children but occurs also in adults. Bacteria spread from the renal pelvis to the tubules by intrarenal reflux. Reflux from the pelvis into the tubules is common: Over 60% of normal kidneys have reflux into at least one papilla. Hematogenous infection of the kidney is uncommon. Factors important in etiology are as follows (Figure 49-1):

Figure 49–1.
Graphic Jump Location

Etiologic factors associated with acute pyelonephritis.


  1. A short urethra, as in females.

  2. Stasis of urine from any cause. The high incidence of urinary infections during pregnancy is believed to be the result of increased serum levels of progesterone, which decreases activity of the urinary tract smooth muscle, promoting stasis of urine.

  3. Structural abnormalities in the urinary tract that promote stasis of urine or establish a communication between the urinary tract and an infected site, such as fistulous tracts between ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessPhysiotherapy Full Site: One-Year Subscription

Connect to the full suite of AccessPhysiotherapy content and resources including interactive NPTE review, more than 500 videos, Anatomy & Physiology Revealed, 20+ leading textbooks, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessPhysiotherapy

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.