scholarly journals Clinical Manifestations and Outcome of Fluoroquinolone Associated Acute Interstitial Nephritis

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S297-S297
Author(s):  
Saira Farid ◽  
Omar AbuSaleh ◽  
Maryam Mahmood ◽  
Zerelda Esquer Garrigos ◽  
Abdurrahman Hamadah ◽  
...  
Keyword(s):  
Renal Function ◽  
Interstitial Nephritis ◽  
Treatment Duration ◽  
Case Reports ◽  
Clinical Manifestations ◽  
Acute Interstitial Nephritis ◽  
Flank Pain ◽  
High Index Of Suspicion ◽  
Baseline Renal Function ◽  
Antibiotic Treatment Duration

Abstract Background Fluoroquinolones (FQ) are among the most commonly prescribed antibiotics. Nephrotoxicity related to FQ use is infrequently reported and the mechanism of renal injury is incompletely elucidated. We describe clinical manifestations and outcome of patients with biopsy proven acute interstitial nephritis (AIN) associated with FQ use at our institution. Methods We conducted a retrospective review of biopsy-proven AIN attributed to FQ use at Mayo Clinic Rochester from 1993 to 2016. Cases were reviewed by a renal pathologist and attributed to FQ use by an expert nephrologist. We also reviewed and summarized all published case reports of biopsy proven AIN that were attributed to FQ use. Results We identified 24 patients with FQ-related biopsy-proven AIN. The most commonly used FQ was ciprofloxacin (71%) with median antibiotic treatment duration of 7 days (Figure 1). The median duration between starting FQ and the diagnosis of AIN was 8.5 (IQR: 17). Common clinical manifestations included fever (50%), flank pain (8%), and skin rash (21%). However, 17% of the patients were asymptomatic at the time of diagnosis (Figure 2). Majority (58%) of the patients recovered following discontinuation of antibiotics and returned to baseline renal function at a median of 20.5 (IQR: 15.5). Six patients required temporary hemodialysis and 9 patients received steroids. Conclusion Onset of FQ-related AIN can be delayed and a high index of suspicion is needed by physicians prescribing these agents. Overall outcomes are favorable with recovery to baseline renal function within 3 weeks of discontinuing the offending drug. Disclosures All authors: No reported disclosures.

scholarly journals Acute Interstitial Nephritis With Karyomegalic Epithelial Cells After Nivolumab Treatment—Two Case Reports

2019 ◽  
Vol 12 ◽  
pp. 117954761985364 ◽  
Author(s):  
Masaki Ryuzaki ◽  
Hirobumi Tokuyama ◽  
Kiyotaka Uchiyama ◽  
Hideaki Nakaya ◽  
Kazuhiro Hasegawa ◽  
...  
Keyword(s):  
Renal Function ◽  
Epithelial Cells ◽  
Interstitial Nephritis ◽  
Checkpoint Inhibitors ◽  
Case Reports ◽  
Kidney Injury ◽  
Corticosteroid Treatment ◽  
Acute Interstitial Nephritis ◽  
Tubular Epithelial Cells ◽  
Ki 67

Clinical application of immune checkpoint inhibitors (CPIs) including nivolumab is expanding in the field of oncology treatment. Nivolumab is an anti-programmed death 1 protein (PD-1) antibody designed to augment an immunologic reaction against cancer cells. On the contrary, CPIs are known to cause a unique variety of side effects termed as immune-related adverse events, which can affect any organ including kidney. However, the characteristics of renal disorders by nivolumab treatment are poorly described. We describe two cases of acute kidney injury that were treated with nivolumab. Two patients, one with renal-cell carcinoma and the other with lung cancer, exhibited progressive renal dysfunction after the initiation of nivolumab treatment. By kidney biopsy, each case was diagnosed as acute interstitial nephritis (AIN). Of note, tubular epithelial cells enlarged with hyperchromatic nuclei were focally observed, and this finding was consistent with karyomegalic tubular epithelial cells. In immunostaining, most of the enlarged tubular epithelial cells were positive for Ki-67, which suggested regeneration of tubular epithelial cells. Clinically, in one case, renal function was partially recovered with the discontinuation of nivolumab, while in another case renal function was fully recovered with additional corticosteroid treatment. We presented nivolumab-induced AIN with karyomegalic changes of tubular epithelia. We propose that immunosuppressive therapy may be necessary for the full recovery from renal impairment.

scholarly journals The mechanisms of acute interstitial nephritis in the era of immune checkpoint inhibitors in melanoma

2019 ◽  
Vol 11 ◽  
pp. 175883591987554 ◽  
Author(s):  
Marco Tucci ◽  
Anna Passarelli ◽  
Annalisa Todisco ◽  
Francesco Mannavola ◽  
Luigia Stefania Stucci ◽  
...  
Keyword(s):  
Renal Function ◽  
Interstitial Nephritis ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Acute Interstitial Nephritis ◽  
Clinical State ◽  
High Dose ◽  
Systemic Symptoms ◽  
The Impact

Treatment with immune checkpoint inhibitors (ICIs) has improved the prognosis of patients with a number of types of cancer, but the frequent development of immune-related adverse effects (irAEs) can worsen the outcome. The most common irAEs involve the gastrointestinal, cutaneous, and endocrine systems, but nephrotoxicity, resulting from damage to the tubule-interstitial compartment, may occur in some patients. The early phases of acute interstitial nephritis (AIN) are characterized by systemic symptoms that indicate a poor clinical state as well as a mild deterioration of renal function. Tubular injury is due to a direct effect mediated by cytotoxic CD8+ T cells, which sustain the local production of pro-inflammatory cytokines that progressively impair renal function. The treatment of AIN is mainly based on high-dose steroids, which in most instances leads to the recovery of renal function. However, the premature discontinuation of ICI therapy may prevent the impact of treatment on the clinical progression of the malignancy. Adequately addressing irAEs requires a standardized therapy that is based on the results of large clinical trials.

Delayed Renal Function Recovery From Drug-Induced Acute Interstitial Nephritis

2012 ◽  
Vol 343 (1) ◽  
pp. 36-39 ◽  
Author(s):  
Dongmei Chen ◽  
Chunlei Luo ◽  
Zheng Tang ◽  
Yan Zhou ◽  
Huiping Chen ◽  
...  
Keyword(s):  
Renal Function ◽  
Interstitial Nephritis ◽  
Acute Interstitial Nephritis ◽  
Drug Induced ◽  
Renal Function Recovery ◽  
Function Recovery

Cloxacillin-Induced Acute Tubulo Interstitial Nephritis

1992 ◽  
Vol 26 (10) ◽  
pp. 1241-1242 ◽  
Author(s):  
Roberto García-Ortiz ◽  
Roberto S. Espinoza ◽  
Gonzalo R. Silva ◽  
Rodrigo K. Alonso ◽  
Hector S. Opazo ◽  
...  
Keyword(s):  
Renal Function ◽  
Interstitial Nephritis ◽  
Case Reports ◽  
Urinary Output ◽  
Lumbar Pain ◽  
Dramatic Improvement ◽  
Beta Lactam ◽  
Drug Induced ◽  
Beta Lactam Antibiotics ◽  
Sterile Pyuria

OBJECTIVE: To report a case of possible cloxacillin-induced acute tubulo interstitial nephritis (AIN). CASE SUMMARY: A 15-year-old male patient presented with hypertension, edema, lumbar pain, sterile pyuria, eosinophiluria (ten percent), and severe renal dysfunction three months after the ingestion of cloxacillin. A renal biopsy revealed diffuse edema and inflammatory infiltrate of the interstitium (five percent eosinophils). He received four sessions of peritoneal dialysis with dramatic improvement in urinary output and renal function. His biochemical parameters returned to normal values 21 days after admission, without the use of glucocorticosteroids. DISCUSSION: Published case reports on AIN induced by penicillin and related drugs are reviewed and compared. The role of interstitial edema in acute renal failure associated with drug-induced AIN is mentioned. CONCLUSIONS: AIN is a rare but significant complication of therapy with penicillin and related drugs. The clinical picture is similar for all of these drugs, but skin rash and fever are absent in AIN induced by cloxacillin and cloxacillin-related drugs. Dialysis improved the patient's urinary output and renal function. Beta-lactam antibiotics should be avoided in patients with cloxacillin-induced AIN.

scholarly journals Longterm renal outcome of biopsy-proven acute tubular necrosis and acute interstitial nephritis

2019 ◽  
Author(s):  
Hyunseo Kim ◽  
Sang Kyung ◽  
Shin Young Ahn ◽  
Young Joo Kwon ◽  
Hajeong Lee ◽  
...  
Keyword(s):  
Renal Function ◽  
Interstitial Nephritis ◽  
Acute Tubular Necrosis ◽  
Female Gender ◽  
Acute Interstitial Nephritis ◽  
Renal Outcome ◽  
Pathological Features ◽  
University Hospitals ◽  
Glomerular Diseases ◽  
Tubular Necrosis

Abstract Background: Although emerging evidence suggest acute kidney injury (AKI) progress to chronic kidney disease (CKD), longterm renal outcome of AKI still remains unclear. Unlike glomerular diseases, AKI is usually diagnosed in the clinical context without kidney biopsies, and lack of histology might contribute to this uncertainty. Acute tubular necrosis (ATN) is the most common cause of AKI due to ischemia, toxin or sepsis. Acute interstitial nephritis (AIN), caused by drugs or autoimmune diseases is also increasingly recognized as an important cause of AKI. Methods: Among 8,769 biopsy series, 253 adults who were histologically diagnosed with ATN and AIN from 1982 to 2018 at five university hospitals were included. Demographic and pathological features that are associated with the development of end stage renal disease (ESRD) were also examined. Results: Rate of non-recovery of renal function at 6 month was significantly higher in the AIN (ATN vs AIN 49.3 vs 69.4%, p=0.007) with a 2.709-fold higher risk of non- recovery compared to ATN (95% CI: 1.203–6.470). During the mean follow up of 76.5±91.9 months, ESRD developed in 39.4% of patients with AIN, and 21.5% patients of ATN. The risk of ESRD was significantly higher in AIN (23.050; 95% CI: 2.420-219.533) and also in ATN (12.136; 95% CI, 1.186-24.235) compared to control with non-specific pathology. Older age, female gender, renal function at the time of biopsy and at 6 months, proteinuria and pathological features including interstitial inflammation and fibrosis, tubulitis, vascular lesion were significantly associated with progression to ESRD. Conclusions: Our study demonstrated that patients with biopsy proven ATN and AIN are at high risk of developing ESRD.

scholarly journals Acute interstitial nephritis with immunotherapy; a growing entity?

2020 ◽  
Vol 9 (4) ◽  
pp. e35-e35
Author(s):  
John David Chetwood ◽  
Lin Lin Myat ◽  
Helen Lammi ◽  
Mani Panat ◽  
James Hughes
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Interstitial Nephritis ◽  
Cancer Survival ◽  
Kidney Injury ◽  
Acute Interstitial Nephritis ◽  
Response To Treatment ◽  
Immune Mediated ◽  
Life Threatening ◽  
Potential Impact

We report a case of acute kidney injury (AKI) secondary to immune-mediated acute interstitial nephritis (AIN), with supporting diagnostic results and a successful response to treatment. This entity is gaining increasing recognition with the burgeoning use of immunotherapy agents in oncology. The timeline for the development of AIN from the initiation of immunotherapy varies, and may range in severity from asymptomatic to severe, organ-threatening and with life threatening consequences. Renal biopsy should be performed to confirm the diagnosis due to the potential impact of discontinuation of immunotherapy on cancer survival. Re-challenge with immunotherapy is reasonable once renal function recovers.

Clozapine-induced interstitial nephritis in a patient with schizoaffective disorder in the forensic setting: a case report and review of the literature

2019 ◽  
pp. 1-6
Author(s):  
C. McLoughlin ◽  
C. Cooney ◽  
R. Mullaney
Keyword(s):  
Renal Function ◽  
Interstitial Nephritis ◽  
Schizoaffective Disorder ◽  
Inflammatory Markers ◽  
Respiratory Symptoms ◽  
Rare Case ◽  
Psychiatric Symptoms ◽  
Acute Interstitial Nephritis ◽  
Review Of The Literature ◽  
Forensic Setting

We present a rare case of Acute Interstitial Nephritis (AIN) that occurred following a re-trial of clozapine in a 56-year-old lady with schizoaffective disorder. On initial trial of clozapine, this patient felt generally unwell with respiratory symptoms. Her inflammatory markers were raised and her renal function showed a mild, transient deterioration which normalised on the day of cessation of clozapine. Two years later, clozapine was re-trialled due the refractory nature of her psychiatric symptoms. She subsequently developed renal failure and AIN was confirmed by renal biopsy. Renal function improved after cessation of clozapine; however, she never fully regained normal renal function.

scholarly journals Use of proton pump inhibitors in dialysis unit in tertiary care hospital: a pharmaco-epidemiological study

2021 ◽  
Vol 10 (6) ◽  
pp. 643
Author(s):  
Shabbir R. Pendhari ◽  
Kedar S. Joshi ◽  
Ramchandra P. Limaye
Keyword(s):  
Interstitial Nephritis ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Case Reports ◽  
Tertiary Care ◽  
Case Series ◽  
Acute Interstitial Nephritis ◽  
Case Report Form ◽  
Care Hospital ◽  
Dialysis Unit

Background: Proton pump inhibitors (PPI) are generally thought to be safer drug with fewer adverse effects. Though this class of the drug is thought to be well tolerated, a detail study about actual use of these agents in nephrology department is still awaited in many parts of India. There had been case reports and case series which were reporting PPIs producing acute interstitial nephritis progressing to acute renal failure. The risk of PPI treatment in haemodialysis patients remains unexplored. The aim of the study was to evaluate a drug utilization of PPI in patient undergoing haemodialysis procedure.Methods: In this study every day visit to the dialysis units of the hospitals was carried out. After taking consent from the patients, the information from the case-report form was noted like; age, sex, diagnosis, laboratory reports and drug prescried. No personally identifiable information about patient or physician was collected. After this an interview of patients was taken.Results: In this study, out of 126 patients 76.6% were male and 23.4% were female. Out of these 126 patients 88.89% patients were on PPI. Nearly 54% were using PPI for more than six months. Nearly 29% patients were using PPI for more than 12 months.Conclusions: As many case-reports and studies are suggesting, there is co-relation of PPI and acute interstitial nephritis from this study we suggest that especially in nephrology unit patients’, more caution must be exercised while using PPI.

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