Tubulointerstitial Disease and Urinary Tract Infections

I.  Program Content

1. Trainees should acquire a general understanding of:

1. The structure and function of the normal renal tubules and interstitium.

2. The pathophysiological mechanisms of acute and chronic interstitial diseases including:
   a.  Immunologically mediated interstitial nephritides.
   b.  Interstitial scarring as a consequence of primary glomerular and
        vascular disease.
   c.  Reflux nephropathy.
   d.  Obstructive nephropathy.

3. Pathophysiology of interstitial disease
   a.  Immunopathogenetic and non-immune mechanisms.
   b.  Relationship to glomerular function.
   c.  Association with major tubular defects -- diabetes insipidus,
        acidification, and potassium excretion.
   d.  Effects of acute and chronic urinary obstruction.

4. Diagnostic procedures.
   a.  Assess tubular defects.
   b.  Evaluate obstruction.
   c.  Define acute and chronic interstitial nephritis.

5. Pathogenesis and treatment of bacterial urinary infections.
   a.  Major pathogenetic species, routes and course of infection.
   b.  Appropriate antibiotic choices.
   c.  Appropriate workup of the patient with multiple or resistance
        infections.

II.   Patient Care Experience

1. Trainees should develop an in-depth knowledge of:

1. The clinical features, causes, course, and treatment of acute allergic interstitial nephritis.

2. The clinical features, predisposing factors, complications, bacteriological profile and treatment of acute pyelonephritis.

3. The management of patients with symptomatic and asymptomatic bacteriuria, including familiarity with:
   a.  The major pathogenic species, routes and course of infection.
   b.  Appropriate antibiotic choices.
   c.  Appropriate workup and treatment of patients with recurrent or
        resistant infections.
   d.  Related syndromes such as nonspecific urethritis, prostatitis,
       hemorrhagic cystitis.

4. Clinical and radiological features, course and treatment of reflux nephropathy (chronic pyelonephritis) and analgesic nephropathy, and the differential diagnosis of papillary necrosis.

2. Trainees should be familiar with:

1. Pathological features of acute and chronic interstitial nephritides.

2. Clinical laboratory tests to evaluate aspects of tubular function, concentrating ability, urine acidification, potassium handling and various reabsorptive function.

3. Trainees should be aware of unusual syndromes affecting the renal interstitium such as zanthogramulomatous pyelonephritis, lympomatous infiltration and various granulomatous diseases.