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.

Prolonged mannerism as an isolated, interesting, and old symptom in a schizophrenic patient with poor response to clozapine: a clinical image

2021 ◽  
Author(s):  
Somayeh Panahi ◽  
Reza Bidaki ◽  
Mohadeseh Asadi
Keyword(s):  
Schizophrenic Patient ◽  
Atypical Antipsychotic ◽  
Neurological Disorder ◽  
Poor Response ◽  
Clinical Image ◽  
Medical Conditions ◽  
Drug Induced ◽  
Specific Symptom ◽  
Wide Range

The concept of catatonia was first described by a German psychiatrist, Kahlbaum, in 1874. Catatonia is a serious neurological disorder associated with a wide range of psychiatric, neurological, medical conditions, and drug-induced disorders. Nevertheless, there is no absolute guideline for treating catatonia patients in whom the cause of the disorder is unknown. Clozapine is the first atypical antipsychotic used for the treatment of catatonia. Our case was a 51-year-old single, right-handed man with schizophrenia and a specific symptom of catatonia. Despite previous studies findings revealing the efficacy of clozapine in relieving catatonia symptoms, our patient did not show a definite response to this medication. Hence, follow-up of these patients to evaluate other treatments and possible incidence or manifest of other catatonic features like waxy flexibility, echo phenomenon, and negativism are suggested.

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

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 Recurrent acute interstitial nephritis: what lies beneath

2020 ◽  
Author(s):  
Fernando Caravaca-Fontán ◽  
Amir Shabaka ◽  
Beatriz Sánchez-Álamo ◽  
Alberto de Lorenzo ◽  
Martha Díaz ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Interstitial Nephritis ◽  
Acute Interstitial Nephritis ◽  
Multivariable Logistic Regression Analysis ◽  
Drug Induced ◽  
Glomerular Diseases ◽  
Acute Kidney Disease ◽  
Observational Cohort ◽  
Retrospective Observational Cohort Study

Abstract Background Acute interstitial nephritis (AIN) is an emerging cause of acute kidney disease. While this disease usually follows an acute course, it may occasionally recur, representing a major challenge for the clinician. Methods We performed a retrospective, observational cohort study in 13 nephrology departments belonging to the Spanish Group for the Study of Glomerular Diseases. Patients with biopsy-proven AIN between 1996 and 2018 were included. Results The study group consisted of 205 patients with AIN, 22 of which developed recurrent AIN (RAIN) after a median of 111 days from diagnosis. RAIN was due to a surreptitious reintroduction of a previously known implicated drug or toxic in six patients (27%), sarcoidosis in two (9%), Sjögren’s syndrome in three (14%), light-chain-mediated AIN in two (9%) and tubulointerstitial nephritis and uveitis syndrome in two (9%), while in the rest of cases (32%), no precise cause could be identified. Microscopic haematuria was more frequent in patients with underlying systemic diseases. The first RAIN episode was treated with a repeated course of corticosteroids in 21 patients (95%). In six cases (27%), azathioprine and mycophenolate mofetil were added as corticosteroid-sparing agents. During a median follow-up of 30 months, 50 patients (27%) with no recurrences and 12 patients (55%) with RAIN reached Stages 4 and 5 chronic kidney disease (CKD). By multivariable logistic regression analysis, RAIN was independently associated with the risk of reaching Stages 4 and 5 CKD, even after adjusting for potential covariables. Conclusions RAIN is infrequent but is associated with poor kidney survival. RAIN should prompt clinicians to search for an underlying aetiology other than drug induced. However, in a large percentage of cases, no precise cause can be identified.

scholarly journals Drug-Induced Granulomatous Interstitial Nephritis in a Patient With Ankylosing Spondylitis During Therapy With Adalimumab

2010 ◽  
Vol 56 (6) ◽  
pp. e17-e21 ◽  
Author(s):  
Peter Korsten ◽  
Nadera J. Sweiss ◽  
Ulf Nagorsnik ◽  
Timothy B. Niewold ◽  
Hermann-Josef Gröne ◽  
...  
Keyword(s):  
Ankylosing Spondylitis ◽  
Interstitial Nephritis ◽  
Drug Induced ◽  
Granulomatous Interstitial Nephritis

scholarly journals Case Report: Pediatric Renal Sarcoidosis and Prognostic Factors in Reviewed Cases

2021 ◽  
Vol 9 ◽  
Author(s):  
Richard Klaus ◽  
Annette Friederike Jansson ◽  
Matthias Griese ◽  
Tomas Seeman ◽  
Kerstin Amann ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Case Report ◽  
Literature Review ◽  
Interstitial Nephritis ◽  
Kidney Biopsy ◽  
Renal Involvement ◽  
Oral Prednisolone ◽  
Renal Outcome ◽  
Granulomatous Interstitial Nephritis

Background: Pediatric sarcoidosis is a complex inflammatory disorder with multisystemic manifestations. Kidney involvement in children is rare, and prognostic factors are unknown.Case Report and Methods: We report the case of a 16-year-old girl with multiorgan sarcoidosis and renal involvement. The patient presented with tubulointerstitial nephritis, acute kidney injury (AKI), chest CT disseminated noduli, granulomatous iridocyclitis, giant-cell sialadenitis, and arthralgia. The kidney biopsy revealed non-granulomatous interstitial nephritis. Treatment consisted of initial high-dose methylprednisolone pulse followed by oral prednisolone and methotrexate. Full remission was achieved. In addition, we performed a literature review using PubMed and analyzed data on pediatric renal sarcoidosis cases.Results: We identified 36 cases of pediatric sarcoidosis with renal involvement on presentation and data on the end-of-follow-up glomerular filtration rate (GFR). The data from the literature review showed that renal involvement was slightly more prevalent in males (60%). AKI was present in most of the described patients (84%). Oral prednisolone was used in 35 of 36 cases; in more severe cases, other immunosuppressants were used. We newly identified renal concentration impairment and granulomatous interstitial nephritis as factors with a clear trend toward GFR loss at the end of follow-up, emphasizing the importance of kidney biopsy in symptomatic patients. In contrast, higher GFR at presentation and hypercalcemia were rather favorable factors. According to the identified predictive factors, our patient has a good prognosis and is in remission.Conclusion: The factors indicating a trend toward an unfavorable renal outcome in pediatric sarcoidosis are renal concentration impairment and granulomatous interstitial nephritis at presentation, while a higher GFR is beneficial.

Drug-induced granulomatous interstitial nephritis in a pediatric patient

2007 ◽  
Vol 22 (2) ◽  
pp. 306-309 ◽  
Author(s):  
James E. Tong ◽  
David N. Howell ◽  
John W. Foreman
Keyword(s):  
Pediatric Patient ◽  
Interstitial Nephritis ◽  
Drug Induced ◽  
Granulomatous Interstitial Nephritis
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