What is the association between chemotherapeutic agents and tubulointerstitial nephritis?
Cisplatin can cause selective injury to proximal tubular cells, where it is taken up by organic cation transporters and accumulates intracellularly.
Clinically, this can manifest as decreased glomerular filtration rate (GFR), Fanconi-like syndrome, salt-wasting, and hypomagnesemia.
Ifosfamide can cause tubular toxicity also resulting in a Fanconi-like syndrome and polyuria due to solute (mainly sodium) diuresis.
High-dose methotrexate can cause ATN secondary to methotrexate crystal precipitation.