Figure 614

Relationship of inulin clearance (A), maximum urine concentration (B), and ammonium excretion in response to an acute acid load (C) to the severity of tubulointerstitial nephritis. A close correlation exists between the severity of chronic TIN and impaired renal tubular and glomerular function. Repeated evaluations of kidney biopsy for the extent of tubulointerstitial lesions have shown a close correlation with renal function test results in tests performed before biopsy. These tests include those for inulin clearance, maximal ability to concentrate the urine, and ability to acidify the urine. This correlation has been validated in a variety of renal diseases, including primary and secondary forms of chronic TIN. (From Shainuck and coworkers [5]; with permission.)

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