TUBULOINTERSTITIAL DAMAGE IN GLOMERULAR-DISEASES - ITS ROLE IN THE PROGRESSION OF RENAL DAMAGE

The evidence that tubular damage, interstitial infiltration, and inter stitial fibrosis occur in all glomerular diseases, either immunologica lly or non-immunologically mediated, is reviewed on the basis of perso nal data and data from the literature. The proposed mechanisms linking glomerular and tubular damage to the interstitial recruitment of mono nuclear leukocytes and fibroblast proliferation, with abnormal extrace llular matrix production leading to interstitial fibrosis, also are an alyzed. The role of persistent heavy proteinuria and exposure to proin flammatory cytokines in inducing the damage of the tubular epithelial cells, with consequent acquisition by these cells of the ability to in teract as antigen-presenting cells with T lymphocytes, is especially e mphasized. Finally, the importance of the tubulointerstitial damage as a marker of unfavorable prognosis in glomerular diseases is documente d. (C) 1995 by the National Kidney Foundation, Inc.