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For most of their history the kidneys were considered parenchymatous secretory glandular organs subservient to the nutritional needs of the body in eliminating excess fluidities, a function they shared with other constitutional emunctory organs. As for their importance, “The kidneys are not present for necessity in animals …” asserted Aristotle (384–322 BC) in the 4th century BC, an unfortunate notion that prevailed for the next 20 centuries. It was only in the nineteenth century that the importance of the kidney began to be appreciated when it was identified as a site of disease by Richard Bright (1789–1858) in 1827 and its functions in maintaining the ‘milieu intérieur’ substantiated by Claude Bernard (1813–1878) in the 1850s. The studies that followed unraveled the misconceptions that had shrouded the kidney in ambiguity over the past and gradually elucidated its central role in maintaining not just water balance but that of total body homeostasis; finally justifying the concluding statement of Aristotle about the kidneys, “… but have the function of perfecting the animal itself.” It is within this evolving framework of accruing renal knowledge that tubulointerstitial nephritis emerged as a pathogenetic destructive process that accounts for the acute onset of some and the progression of most chronic diseases of the kidney.