Analgesic nephropathy

Excessive analgesic use >3 years in various combinations, including NSAIDs; more frequent in women

Hypertension, nocturia, sterile leukocyturia, hemolytic anemia; characteristic papillary calcifications on CT; small kidneys with irregular outlines, features of papillary necrosis; increased incidence of urinary system cancers

Lithium-associated nephropathy

Treatment with lithium for ~15 years

Proteinuria >1 g/d, hypertension, possibly NDI

Lead nephropathy

Long-term exposure to lead (lead smelters, paint or battery manufacturing/recycling plants, oil refineries)

Serum lead may not be elevated but urinary lead excretion (>0.6 mg/d after IV infusion of sodium versenate) is evidence of increased lead burden; high serum uric acid, gout (~50%)

Uric acid (gouty) nephropathy

Long-standing inconsistently treated hyperuricemia

Hypertension, proteinuria <1 g/d, decreased urinary concentrating ability, frequently uric acid nephrolithiasis

Hypercalcemic nephropathy

Chronic hypercalcemia

NDI (~20%), renal sodium loss, distal RTA; possible nephrocalcinosis and urolithiasis; acute hypercalcemia may be cause of AKI

Hypokalemic nephropathy

Chronic hypokalemia

Extrarenal symptoms of hypokalemia; NDI, renal cysts

Hyperoxaluric nephropathy

Congenital metabolic defect (primary hyperoxaluria); complication of extensive small bowel resection or gastric/bariatric bypass surgery or in patients with IBD

Nephrocalcinosis, nephrolithiasis

Sjögren syndrome

Symptoms of underlying condition (CIN develops within 2-4 y of disease onset); NDI (~10%), distal RTA (~5%), renal potassium loss

Radiation nephritis

Several years after exposure to cumulative radiation dose >23 Gy (2300 rad)

Hypertension, proteinuria, slow reduction in GFR

Aristolochic acid nephropathy (Chinese herbal nephropathy)

Chinese herbal preparations (made of Aristolochia plant, traditional Chinese names: Mu Tong, Fang Ji) that contain aristolochic acid (nephrotoxic alkaloid; used for weight loss or skin diseases)

Moderate proteinuria, glycosuria, no abnormalities of urinary sediment; severe anemia; diagnosis confirmed by detection of metabolites of aristolochic acid in DNA of renal cells; rapid GFR impairment, which may be partially inhibited by glucocorticoids; RRT necessary in >80% of patients within 2 years; urinary system cancers develop in 40%-50%

Balkan endemic nephropathy

Endemic along tributaries of the Danube River (Bulgaria, Romania, Bosnia and Herzegovina, Croatia, Serbia); long-term exposure to aristolochic acid contained in cereal products plus genetic predisposition

Progressive anemia and GFR reduction, rarely hypertension; ESRD develops within 15-20 years; ~100-fold increase in incidence of urinary system cancers

Hereditary interstitial kidney diseases

Include autosomal recessive disorders (nephronophthisis) diagnosed in children and autosomal dominant disorders (ADTKD) typically diagnosed in adulthood

– Nephronophthisis (form of ciliopathy); ESRD in teenagers to patients in their 20s, salt wasting, urinary concentrating defect, occasional medullary cysts on US, extrarenal involvement (CNS, liver)

– ADTKD: Slowly progressive kidney failure, bland urinalysis, unremarkable renal US; strong family history of ESRD in patients in their 30s-60s. More common mutations include UMOD gene encoding uromodulin (may present with history of gout), MUC1 gene encoding mucin 1, and REN gene encoding renin (may present with mild hypotension and hyperkalemia)

Papillary necrosis

Ischemic or toxic kidney damage (analgesics, NSAIDs); risk factors: diabetes, urinary obstruction, UTI, analgesics, NSAIDs

Polyuria, nocturia, renal colic; urinalysis: proteinuria, leukocyturia, microscopic hematuria; diagnosis: urography, antegrade pyelography