Tubulointerstitial injury in glomerulonephritis

It is now widely accepted that tubulointerstitial lesions correlate with renal function in glomerulonephritis and that the severity of such lesions predicts disease progression. Interstitial leucocytic infiltration is a prominent feature of tubulointerstitial lesions which also correlates with renal function and outcome in human glomerulonephritis, while intervention studies in animal disease models have demonstrated a causal role of these cells in progressive tubulointerstitial injury. This paper focuses on two aspects of immune-mediated tubulointerstitial injury. First, the development of interstitial leucocytic infiltration and the relationship between periglomerular leucocytes and Bowman's capsule integrity, and second, the concept that tubular cells are not only passive targets of injury in glomerulonephritis, but that they actively participate in the immune/inflammatory process.