scholarly journals Granulomatous interstitial nephritis: a rare diagnosis with an overlooked culprit

2019 ◽  
Vol 12 (8) ◽  
pp. e229159 ◽  
Author(s):  
Ana Carolina Figueiredo ◽  
Luís Rodrigues ◽  
Vítor Sousa ◽  
Rui Alves
Keyword(s):  
Interstitial Nephritis ◽  
Kidney Biopsy ◽  
Renal Ultrasound ◽  
Tubulointerstitial Injury ◽  
Drug Induced ◽  
Urine Sediment ◽  
Granulomatous Interstitial Nephritis ◽  
History Of ◽  
Inflammatory Drugs ◽  
Rare Diagnosis

Granulomatous interstitial nephritis (GIN) is a rare entity identified in <1% of native kidney biopsies. The most frequent aetiology is drug-related, followed by systemic granulomatous conditions. Among drugs implicated in GIN, antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs) are the most frequent. We report the case of a 45-year-old white man referred to a nephrology consult due to chronic kidney disease. He had a history of arterial hypertension with 10 years of evolution, hyperuricaemia, medicated with allopurinol and NSAID abuse for at least 20 years. Urine sediment was blunt, without proteinuria. Renal ultrasound was normal. A kidney biopsy revealed well-defined epithelioid granulomas with glomerular wrinkling and collapse. Infectious and systemic conditions were excluded, favouring the hypothesis of drug-induced GIN, probably related to NSAIDs. Kidney biopsy remains the gold standard for the diagnosis of GIN. Facing a patient with renal failure without significant proteinuria or active sediment, one should look for causes of tubulointerstitial injury.

scholarly journals Acute interstitial nephritis and drug-induced systemic lupus erythematosus due to chlorthalidone and amiodarone: A case report

2020 ◽  
Vol 8 ◽  
pp. 2050313X2091002 ◽  
Author(s):  
Umut Selamet ◽  
Ramy M Hanna ◽  
Anthony Sisk ◽  
Lama Abdelnour ◽  
Lena Ghobry ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Interstitial Nephritis ◽  
Lupus Erythematosus ◽  
Kidney Biopsy ◽  
Kidney Injury ◽  
Acute Interstitial Nephritis ◽  
Systemic Lupus ◽  
Drug Induced ◽  
Systemic Manifestations

Drug-induced lupus erythematosus has features distinct from primary systemic lupus erythematosus. It can occur with a wide variety of agents that result in the generation of anti-histone or other types of antibodies. Systemic manifestations of drug-induced systemic lupus erythematosus may include renal dysfunction due to circulating immune complexes or due to other immune reactions to the culprit medication(s). Acute interstitial nephritis occurs due to DNA–drug or protein–drug complexes that trigger an allergic immune response. We report a patient who developed acute kidney injury, rash, and drug-induced systemic lupus diagnosed by serologies after starting chlorthalidone and amiodarone. A renal biopsy showed acute interstitial nephritis and not lupus-induced glomerulonephritis. It is important to note that systemic lupus erythematosus and acute interstitial nephritis can occur together, and this report highlights the role of the kidney biopsy in ascertaining the pathological diagnosis and outlining therapy in drug-induced lupus erythematosus.

scholarly journals Granulomatous interstitial nephritis in a patient with SARS-CoV-2 infection

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Katarzyna Szajek ◽  
Marie-Elisabeth Kajdi ◽  
Valerie A. Luyckx ◽  
Thomas Hans Fehr ◽  
Ariana Gaspert ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Interstitial Nephritis ◽  
Kidney Biopsy ◽  
Kidney Diseases ◽  
Case Reports ◽  
Kidney Injury ◽  
Maculopapular Rash ◽  
Tubular Injury ◽  
Granulomatous Interstitial Nephritis ◽  
First Case

Abstract Background Acute kidney injury (AKI) associated with severe coronavirus disease 19 (COVID-19) is common and is a significant predictor of morbidity and mortality, especially when dialysis is required. Case reports and autopsy series have revealed that most patients with COVID-19 – associated acute kidney injury have evidence of acute tubular injury and necrosis - not unexpected in critically ill patients. Others have been found to have collapsing glomerulopathy, thrombotic microangiopathy and diverse underlying kidney diseases. A primary kidney pathology related to COVID-19 has not yet emerged. Thus far direct infection of the kidney, or its impact on clinical disease remains controversial. The management of AKI is currently supportive. Case Presentation The patient presented here was positive for SARS-CoV-2, had severe acute respiratory distress syndrome and multi-organ failure. Within days of admission to the intensive care unit he developed oliguric acute kidney failure requiring dialysis. Acute kidney injury developed in the setting of hemodynamic instability, sepsis and a maculopapular rash. Over the ensuing days the patient also developed transfusion-requiring severe hemolysis which was Coombs negative. Schistocytes were present on the peripheral smear. Given the broad differential diagnoses for acute kidney injury, a kidney biopsy was performed and revealed granulomatous tubulo-interstitial nephritis with some acute tubular injury. Based on the biopsy findings, a decision was taken to adjust medications and initiate corticosteroids for presumed medication-induced interstitial nephritis, hemolysis and maculo-papular rash. The kidney function and hemolysis improved over the subsequent days and the patient was discharged to a rehabilitation facility, no-longer required dialysis. Conclusions Acute kidney injury in patients with severe COVID-19 may have multiple causes. We present the first case of granulomatous interstitial nephritis in a patient with COVID-19. Drug-reactions may be more frequent than currently recognized in COVID-19 and are potentially reversible. The kidney biopsy findings in this case led to a change in therapy, which was associated with subsequent patient improvement. Kidney biopsy may therefore have significant value in pulling together a clinical diagnosis, and may impact outcome if a treatable cause is identified.

scholarly journals A Rare Case of Rituximab Induced Allergic Interstitial Nephritis with a Good Response to Glucocorticoids

2021 ◽  
Vol 2 (2) ◽  
pp. 80-83
Author(s):  
Vrushali Dabak
Keyword(s):  
Interstitial Nephritis ◽  
Kidney Biopsy ◽  
Central Nervous System Lymphoma ◽  
Hematologic Malignancies ◽  
Drug Induced ◽  
First Case ◽  
Autoimmune Conditions ◽  
Anti Cd20 ◽  
High Index Of Suspicion ◽  
Wide Usage

Rituximab is a chimeric anti-CD20 monoclonal antibody that has been widely used to treat CD 20 positive hematologic malignancies and some autoimmune conditions. Although usually well tolerated, an increasing number of serious complications related to rituximab have been noted with its wide usage. We report a 67-year-old man who developed biopsy-proven Allergic Interstitial Nephritis (AIN) after treatment with rituximab for his Primary Central Nervous System Lymphoma (PCNSL). Rituximab-induced AIN was confirmed by kidney biopsy, and his kidney function improved to his baseline with supportive care and four weeks of steroid treatment. While rare, AIN could be a possible adverse effect of rituximab. To our knowledge, this is the first case report of a biopsy-proven AIN from rituximab. The association of AIN and rituximab in our case necessitates a high index of suspicion to facilitate early detection of AIN and timely discontinuation of the offending medication. Keywords: Rituximab; Drug induced allergic interstitial nephritis.

scholarly journals What about NSAID and secondary minimal change disease in adult’s people? A case report and review of the literature

2021 ◽  
Vol 7 (1) ◽  
pp. e12-e12
Author(s):  
Erica E Faure ◽  
Jorge H. Mukdsi
Keyword(s):  
Nephrotic Syndrome ◽  
Minimal Change Disease ◽  
Clinical Presentation ◽  
The Elderly ◽  
Minimal Change ◽  
Glomerular Injury ◽  
Drug Induced ◽  
History Of ◽  
Histological Characteristics ◽  
Inflammatory Drugs

Non-steroidal anti-inflammatory drugs (NSAIDs) have been used in the management of inflammatory disease for decades. The spectrum of nephrotoxicity attributed to NSAIDs includes mainly acute tubulointerstitial nephritis. However, much less attention has been given to drug-induced glomerular injury. NSAIDs treating patients presenting with nephrotic syndrome may have a variety of glomerular changes indistinguishable from those found in idiopathic minimal change disease (MCD), for example. The clinical presentation is typically abrupt with nephrotic syndrome while in the elderly it can present as acute renal failure from the beginning. We present an MCD-NSAID induced in elderly patient and discuss possible pathogenic mechanism, thinking about on the indiscriminate use of NSAIDs. Here we report the case of a 66-year-old woman with a history of nephrotic syndrome and hypertension without an apparent secondary etiology. However, an exhaustive history showed and indiscriminate use of NSAIDs. Renal biopsy showed a MCD with a mild interstitial nephritis. To our knowledge the morphology of drug-induced diseases often does not differ from the primary forms, making the distinction difficult. There are subtle clues, although the dialogue between clinician and pathologist is essential to reach an etiological diagnosis. Physicians should suspect glomerulonephritis in patients who receive drugs and its management must be determined based on the histological characteristics of the disease. Although corticosteroid therapy seems to be of value, the effectiveness of this approach must still be tested in randomized and multicentric clinical trials.

Extension of indications for local application of Dolgit cream for vertebrogenic pain syndromes

1997 ◽  
Vol 78 (3) ◽  
pp. 230-231
Author(s):  
D. V. Kamzeev ◽  
V. F. Bogoyavlensky ◽  
R. M. Gazizov ◽  
V. P. Veselovsky
Keyword(s):  
Risk Factors ◽  
Female Gender ◽  
Gastrointestinal Diseases ◽  
Older Age ◽  
Gastric Bleeding ◽  
Drug Induced ◽  
Pain Syndromes ◽  
Gastrointestinal Pathology ◽  
History Of ◽  
Inflammatory Drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used to relieve the pain (algic) syndrome. However, their oral use is limited because of the development of drug-induced gastropathies, including gastric bleeding, gastric or intestinal ulcer perforations. Risk factors for drug-induced gastropathies include older age, female gender, smoking, taking corticosteroids along with NSAIDs, and a history of gastrointestinal pathology (ulcers, gastritis, bleeding). The risk of gastropathy complications is especially high in those who suffer from chronic gastrointestinal diseases.

Drug-Induced Sarcoid-Like Granulomatous Interstitial Nephritis in a Patient with JIA

2012 ◽  
Vol 1 (4) ◽  
pp. 231
Author(s):  
Kadriye Ozdemir ◽  
Betul Sozeri ◽  
Nida Dincel ◽  
Sevgi Mir ◽  
Sait Sen
Keyword(s):  
Interstitial Nephritis ◽  
Drug Induced ◽  
Granulomatous Interstitial Nephritis

scholarly journals Granulomatous interstitial nephritis associated with atypical drug-induced hypersensitivity syndrome induced by carbamazepine

2011 ◽  
Vol 16 (1) ◽  
pp. 168-172 ◽  
Author(s):  
Eriko Eguchi ◽  
Keiji Shimazu ◽  
Kensuke Nishiguchi ◽  
Soushi Yorifuji ◽  
Atsuo Tanaka ◽  
...  
Keyword(s):  
Interstitial Nephritis ◽  
Hypersensitivity Syndrome ◽  
Drug Induced ◽  
Granulomatous Interstitial Nephritis

Acetazolamide-Induced Aseptic Meningitis in a Female Adolescent with Idiopathic Intracranial Hypertension: A Case Report

2019 ◽  
Vol 18 (04) ◽  
pp. 198-200
Author(s):  
Rekha Gupta ◽  
Chris Barton ◽  
Vinay Puri
Keyword(s):  
Intracranial Hypertension ◽  
Aseptic Meningitis ◽  
Idiopathic Intracranial Hypertension ◽  
Female Adolescent ◽  
Drug Induced ◽  
History Of ◽  
Cerebrospinal Fluid Culture ◽  
Inflammatory Drugs ◽  
Management Challenge ◽  
Fluid Culture

AbstractDrug-induced aseptic meningitis (DIAM) has been documented for many years and is considered a diagnostic and patient management challenge. Associated medications include nonsteroidal anti-inflammatory drugs, antibiotics, and monoclonal antibodies, but no cases associated with acetazolamide have been reported. We briefly review a case of a 15-year-old female patient with history of idiopathic intracranial hypertension whose symptoms of aseptic meningitis associated with the use and increase of acetazolamide. DIAM should be considered a possibility in any patient with meningeal symptoms, pleocytosis, and negative cerebrospinal fluid culture. This is the first known case linking acetazolamide to DIAM.

scholarly journals Idiopathic granulomatous interstitial nephritis and isolated renal sarcoidosis: Two diagnoses of exclusion

2021 ◽  
Vol 9 ◽  
pp. 205031212110384
Author(s):  
Ulf Janssen ◽  
Shirin Naderi ◽  
Kerstin Amann
Keyword(s):  
Interstitial Nephritis ◽  
Poor Response ◽  
Drug Induced ◽  
Vitamin D Metabolism ◽  
Granulomatous Interstitial Nephritis ◽  
Common Causes ◽  
Extrarenal Manifestations ◽  
Extrarenal Involvement ◽  
Infectious Etiology

Granulomatous interstitial nephritis is a rare finding in renal biopsy caused by drugs, infections, and inflammatory or autoimmune diseases. Idiopathic cases account for 18% of granulomatous interstitial nephritis in native kidneys. Sarcoidosis and drugs are the most common causes of granulomatous interstitial nephritis in Western countries, while in India tuberculosis prevails. Few cases of renal sarcoidosis without extrarenal involvement, that is, isolated renal sarcoidosis, have been reported. The diagnostic criteria of isolated renal sarcoidosis remain, however, unclear. Extrarenal sarcoidosis and other etiologies of granulomatous interstitial nephritis, in particular drug-related, have to be excluded. Some of these patients may develop extrarenal manifestations during follow-up. Changes in calcium and vitamin D metabolism are frequently observed in renal sarcoidosis and support its diagnosis. While non-necrotizing granulomas are a feature of sarcoidosis and drug-induced granulomatous interstitial nephritis, they also prevail in tuberculosis-associated granulomatous interstitial nephritis. Granulomatous interstitial nephritis caused by sarcoidosis and drugs usually responds to steroid therapy. A poor response to steroids may indicate an infectious etiology such as tuberculosis and should lead to a review of the initial diagnosis. This article gives an overview of the various etiologies of granulomatous interstitial nephritis, their frequency and histopathological characteristics, as well as potential biomarkers associated with renal sarcoidosis.

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