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Tubulointerstitial Nephritis in a Young Patient

A 19 year old woman presents with hypertension and CKD. Her urinalysis is entirely normal and her kidneys are slightly echogenic. A renal biopsy has only 3 glomeruli, 2 of which are globally sclerosed, and there is extensive acute and chronic interstitial inflammation. What has caused this severe renal disease in such a young woman? Can hypertension alone explain these findings? What other work-up should be considered? Should genetic testing be done for autosomal dominant interstitial nephritis or nephronophthisis? Should she receive an empiric trial of steroids? Is there a role for another biopsy? Read the thread to see what the discussants decide. 

Summary provided by Roger Rodby MD, FACP, FASN