341 Ch 340. Tubulointerstitial Diseases and Drug-Induced Nephropathy

Tubulointerstitial diseases = 主要影響 tubules + interstitium (而非 glomeruli)；分 acute (AIN) vs chronic (CIN)；AIN (acute interstitial nephritis) = 多由 drug (PPI, NSAIDs, antibiotics, ICI)、infection、autoimmune (Sjögren, IgG4, sarcoidosis)；典型 features：AKI + WBC casts + urine eosinophils (low sensitivity) + 系統 hypersensitivity (rash, fever, eosinophilia in some)；治療 = hold offending drug + corticosteroids if severe / persistent；chronic interstitial nephritis (CIN) = 慢性 — lithium nephropathy, analgesics, lead, cadmium, balkan endemic nephropathy, aristolochic acid (中草藥), reflux nephropathy；RTA (renal tubular acidosis) 分 type 1 (distal), type 2 (proximal), type 4 (hypoaldosterone, K-sparing diuretic)；Fanconi syndrome = proximal tubular dysfunction with glucosuria, aminoaciduria, phosphaturia, type 2 RTA；hereditary: ADPKD, Alport, cystinosis, polycystin, NPHP；2024 ICI nephritis 上升 — 識別 + steroid 治療。