Center for Tubulointerstitial Kidney Disease

At Stanford’s Division of Nephrology, we are committed to improving the understanding of causes and management of tubulointerstitial kidney disease (also known as tubulointerstitial nephritis or interstitial nephritis), through rigorous research and excellent clinical care.

Tubulointerstitial nephritis is a common form of kidney disease. While nephrologists have identified many potential triggers for acute interstitial nephritis, we know less about why patients may develop chronic interstitial nephritis. Ideal management strategies for both acute and chronic disease are unclear. Also a regional form of tubulointerstitial nephritis called Chronic kidney disease of unknown etiology has been described in Sri Lanka. Similarly Meso American nephropathy has been described in Nicaragua and El Salvador.

As Director of Stanford’s Center for Tubulointerstitial Kidney Disease, Dr. Anand is building a clinical and research portfolio focused on tubulointerstitial kidney disease.

Research Activities

Drs. Anand, Bhalla, Kambham and Montez-Rath are engaged in multi-disciplinary work researching CKDu (Chronic kidney disease of unknown etiology), the epidemiology and cause of a tubulointerstitial nephritis occurring at a high rate in Sri Lanka, predominantly among middle-age farm workers. These multi-disciplinary projects engage nephrologists, environmental scientists, anthropologists, epidemiologists and basic scientists. They are a collaboration with Kandy Teaching Hospital and University of Peridenya in Sri Lanka and University of Connecticut. This work recently highlighted in the Stanford Department of Medicine Annual Report.

Clinical Activities

Dr Anand has developed a standardized  approach for evaluation of patients with non-proteinuric kidney disease, especially for those suspected of having tubulointerstitial nephritis (or chronic interstitial nephritis) but also in patients with diabetes or hypertension who don’t have supportive features of diabetic nephropathy or renovascular disease.  Common causes of interstitial nephritis are medications. and environmental exposures including lead, cadmium (Itai-Itai disease) and aristolochic acid (Balkan nephropathy or Chinese herb nephropathy). Preliminary data show that early initiation of steroids in drug-induced acute interstitial nephritis or chronic interstitial nephritis may result in better outcomes.

Our projects

Case definition for CKDu

This work involves the development of a case definition and detailed and follow up assessment of established patients to identify potential causative agents.

Acute interstitial nephritis in CKDu

A subset of patients with CKDu present with symptomatic (or asymptomatic) AIN; we are working with collaborators at Kandy Teaching hospital to further characterize this phase of the disease.   

Predictors of CKDu progression

Led by the University of Connecticut this work engages patients with CKDu, to determine if rates of progression differ and to understand correlates of progression.  A preliminary protocol of this study which integrates demographic, behavioral, clinical, and environmental exposure assessment will be available shortly.


2018 - SRI LANKA

Field team in Sri Lanka investigating CKDu


CKDu endemic areas, Teaching Hospital Kandy, and Girandurukotte, Sri Lanka


Nishantha Nanayakkara

Nephrologist, Kandy Teaching Hospital, Kandy, Sri Lanka

Our projects are co-led by Nishantha Nanayakkara who provides extensive and expanding care to persons with CKDu, and has a long, established relationship with the community. He conducts satellite clinics in areas which are affected, with CKDu. He is an advisor to the Centre for Education, Research and Training on Kidney Diseases (CERTKiD) in Faculty of Medicine, the University of Peradeniya which is one of the leading institutes investigating current epidemic, chronic kidney disease of uncertain etiology (CKDu). Currently several M.Phil and Ph.D. students conduct their research under the supervision of Dr. Nanayakkara.


Shuchi Anand

Vivek Bhalla

Neeraja Kambham

As an academic renal pathologist with over 17 years of experience, Dr. Kambham has focused her clinical and translational research efforts in the areas of medical kidney diseases and transplant pathology.  Primary tubulointerstitial diseases seen in native kidneys can often go unrecognized and the biopsy changes can be labeled as nonspecific. With concerted efforts, we hope to address these diagnostic challenges and contribute to better understanding of the disease mechanisms.

Brian Brady

Maria Montez Rath

Dr. Montez-Rath completed her PhD in Biostatistics from Boston University in 2008 focusing on methods for modeling interaction effects in studies involving populations with high levels of comorbidity, such as persons on dialysis. She is a senior biostatistician and director of the Biostatistics Core of the Division of Nephrology at Stanford University where she has been collaborating with faculty and fellows since 2010 to study a variety of research questions relevant to kidney disease.

Anjali Bhatt Saxena

Dr. Saxena is heavily involved in the international PD community. She assumed the role of Treasurer for the International Society for Peritoneal Dialysis (ISPD) in January 2017, and is currently the President of the North American Chapter of the ISPD. She is committed to providing education and support for home dialysis therapies locally, nationally, and internationally. She is also an approved Educational Ambassador for the International Society of Nephrology (ISN), and has worked alongside Stanford colleagues to help develop services and training courses in Peritoneal Dialysis a low income area of Sri Lanka.

Contact Us

If you would like to contact Dr. Anand regarding a specific patient, please email To be HIPPA compliant please ensure your initial email does not have identifiable details.