Acute Interstitial Nephritis: A Rare and Unusual Side Effect of Omalizumab

Acute interstitial nephritis (AIN) is a relatively common cause of acute kidney injury with etiologies that include drug therapy, infections, and systemic diseases. Of these etiologies, drug therapy accounts for ~70% of AIN cases. Although any drug can cause AIN, there are no reported cases of AIN caused by omalizumab, a humanized monoclonal antibody that binds to and inhibits circulating immunoglobulin E. In this article, we share the first reported case of AIN following administration of omalizumab for the treatment of moderate to severe persistent asthma.

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Changes in the aetiology, clinical presentation and management of acute interstitial nephritis, an increasingly common cause of acute kidney injury

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfu326 ◽

2014 ◽

Vol 30 (9) ◽

pp. 1472-1479 ◽

Cited By ~ 54

Author(s):

Manuel Praga ◽

Angel Sevillano ◽

Pilar Auñón ◽

Ester González

Keyword(s):

Acute Kidney Injury ◽

Interstitial Nephritis ◽

Clinical Presentation ◽

Kidney Injury ◽

Acute Interstitial Nephritis ◽

Common Cause

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Diagnosing acute interstitial nephritis: considerations for clinicians

Clinical Kidney Journal ◽

10.1093/ckj/sfz080 ◽

2019 ◽

Cited By ~ 1

Author(s):

Eliezer Zachary Nussbaum ◽

Mark A Perazella

Keyword(s):

Interstitial Nephritis ◽

Kidney Biopsy ◽

Laboratory Data ◽

Kidney Injury ◽

Clinical History ◽

Acute Interstitial Nephritis ◽

Single Test ◽

Common Cause ◽

Tubular Necrosis ◽

Common Causes

Abstract Acute interstitial nephritis (AIN) is a common cause of acute kidney injury (AKI), particularly in hospitalized patients. It can be difficult for clinicians to differentiate between AIN and other common causes of AKI, most notably acute tubular necrosis (ATN) and prerenal injury. Clinicians often struggle with the clinical history and laboratory data available to definitively diagnose AIN. Sometimes they diagnose ATN or AIN based on these flawed data. Thus it is important that clinicians be familiar with the utility of commonly ordered tests used to aid in the diagnosis. Unfortunately, no single test performs particularly well on its own, and until a biomarker is rigorously shown to be diagnostic of AIN, most patients require a kidney biopsy to definitively establish the diagnosis and direct further management.

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

SAGE Open Medical Case Reports ◽

10.1177/2050313x20910029 ◽

2020 ◽

Vol 8 ◽

pp. 2050313X2091002 ◽

Cited By ~ 1

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.

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Rifampicin Induced Acute Interstitial Nephritis in a Patient with Tubercular Lymphadenitis: A Case Report

BIRDEM Medical Journal ◽

10.3329/birdem.v8i3.38134 ◽

2018 ◽

Vol 8 (3) ◽

pp. 257-259

Author(s):

Hafsa Hassan Khan ◽

Muhammad Abdur Rahim ◽

Mehruba Alam Ananna ◽

Tufayel Ahmed Chowdhury ◽

Sarwar Iqbal

Keyword(s):

Acute Kidney Injury ◽

Case Report ◽

Adverse Effects ◽

Interstitial Nephritis ◽

Case History ◽

Kidney Injury ◽

Acute Interstitial Nephritis ◽

History Of ◽

Tubercular Lymphadenitis ◽

Prompt Diagnosis

Rifampicin is one of the most effective anti-tubercular agents. Among its rare adverse effects, acute interstitial nephritis (AIN) is noteworthy. Here, we describe the case history of a 55-year-old female with tubercular lymphadenitis who developed rifampicin induced AIN upon re-exposure and recovered satisfactorily without requiring steroids. Rifampicin induced AIN should be kept in mind when patients present with acute kidney injury as prompt diagnosis and discontinuation of the drug has excellent prognosis.Birdem Med J 2018; 8(3): 257-259

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Time to Acute Kidney Injury in β-Lactam−Induced Acute Interstitial Nephritis

Kidney International Reports ◽

10.1016/j.ekir.2020.04.008 ◽

2020 ◽

Vol 5 (7) ◽

pp. 1068-1070 ◽

Cited By ~ 1

Author(s):

Benjamin Lazarus ◽

Matthew R.P. Davies ◽

Jason A. Trubiano ◽

Rebecca Pellicano

Keyword(s):

Acute Kidney Injury ◽

Interstitial Nephritis ◽

Kidney Injury ◽

Acute Interstitial Nephritis

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Association of Acute Interstitial Nephritis with Carnivora, a Venus Flytrap Extract, in a 30-Year-Old Man with Hodgkin’s Lymphoma

Case Reports in Nephrology ◽

10.1155/2014/486173 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4

Author(s):

Susan Ziolkowski ◽

Catherine Moore

Keyword(s):

Amino Acids ◽

Interstitial Nephritis ◽

Hodgkin’S Lymphoma ◽

Kidney Injury ◽

Acute Interstitial Nephritis ◽

Cell Uptake ◽

Hodgkin's Lymphoma ◽

Venus Flytrap ◽

Proximal Tubular ◽

Possible Cause

Acute interstitial nephritis (AIN) is a common cause of acute kidney injury and has been associated with a variety of medications. This is the case of 30-year-old man with Hodgkin’s lymphoma who on routine labs before chemotherapy was found to have acute nonoliguric renal failure. A kidney biopsy was performed and confirmed the diagnosis of acute interstitial nephritis. The patient had taken several medications including a higher dose of Carnivora, a Venus flytrap extract, composed of numerous amino acids. The medication was discontinued and kidney function improved towards the patient’s baseline indicating that this may be the possible cause of his AIN. Proximal tubular cell uptake of amino acids increasing transcription of nuclear factor-kappaB is a proposed mechanism of AIN from this compound.

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Frequency of Raised Total Serum Ig E, Sputum Eosinophilia and Blood Eosinophil Count in Patients with Severe Persistent Asthma

Proceedings of Shaikh Zayed Medical Complex Lahore - October to December ◽

10.47489/p000s351z7791-4mc ◽

2021 ◽

Vol 35 (1) ◽

Author(s):

Shanawer Qaiser

Keyword(s):

Eosinophil Count ◽

Inflammatory Markers ◽

Immunoglobulin E ◽

Persistent Asthma ◽

Serum Immunoglobulin ◽

Total Serum ◽

Blood Eosinophil ◽

Blood Eosinophil Count ◽

Sputum Eosinophilia ◽

Severe Persistent Asthma

Introduction: Asthma is a chronic inflammatory airway disorder that has several inflammatory phenotypes. Serum immunoglobulin E (IgE) and eosinophils are airway inflammation markers in asthmatic patients. In this research, we assessed the asthma severity with various inflammatory markers. Aims & Objectives: To find the frequency of raised total serum immunoglobulin E, sputum eosinophilia, and absolute blood eosinophil count in patients with severe persistent asthma. Place and duration of study: This study was conducted in Department of Pulmonology, Shaikh Zayed FPGMI, Lahore from 1st October 2018 to 1st April 2019. Material & Methods: A Cross-sectional study in which total of 125 patients were enrolled after fulfilling the inclusion criteria. Blood samples were taken with aseptic measures for total serum immunoglobulin E and absolute blood eosinophils count. Sputum was collected in the sterile jar and dispensed properly to the histopathology lab. Results: Of 125 patients, 44.8% were males, and 55.2% were females. The mean patient's age was 49.37 years, and the mean duration of symptoms was 25.49 years. Raised serum immunoglobulin E levels were seen in 74.4% patients, sputum eosinophilia was seen in 25.6% patients, and increased peripheral eosinophil count was seen in 55.2%. Age was significantly associated with sputum eosinophilia; however, no such association was seen between the other effect modifiers and inflammatory markers. Conclusion: Inflammatory markers immunoglobulin E, sputum and blood eosinophil levels were significantly raised in asthma patients. These can be used in the detection of asthma as their detection is easy, simple, and non-invasive, and they are directly linked to the inflammation.

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Acute interstitial nephritis with immunotherapy; a growing entity?

Journal of Renal Injury Prevention ◽

10.34172/jrip.2020.35 ◽

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.

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AIN’t got no easy answers: recent advances and ongoing controversies around acute interstitial nephritis

Clinical Kidney Journal ◽

10.1093/ckj/sfz138 ◽

2019 ◽

Author(s):

Joshua Storrar ◽

Alexander Woywodt ◽

Cheralathan Arunachalam

Keyword(s):

Interstitial Nephritis ◽

Kidney Injury ◽

Acute Interstitial Nephritis ◽

Serum Biomarkers ◽

New Drugs ◽

Diagnostic Tools ◽

Future Research ◽

High Degree ◽

Direct Management ◽

New Anticancer Drugs

Abstract Acute interstitial nephritis (AIN) is a common cause of acute kidney injury that was first described in 1898. It is most commonly caused by drugs and infections, although other aetiologies are implicated. Here we review two papers published in this issue of Clinical Kidney Journal and provide an update on current advances and controversies relating to AIN. Nussbaum and Perazella describe the diagnostic tools (namely urinary and serum biomarkers) available for AIN and highlight that there is no single test that can accurately predict the diagnosis. As such, renal biopsy remains the gold standard. Wendt et al. present findings from a 20-year retrospective study of biopsy-proven AIN. They found that a high degree of inflammation was associated with a greater chance of renal recovery, in contrast to the presence of cortical scars, which were associated with a worse outcome. There was also a significant number who required renal replacement therapy. They advocate the use of a scoring system for AIN to help direct management. We also discuss new drugs associated with AIN (in particular new anticancer drugs) and unusual forms including granulomatous AIN. Finally, we discuss the opportunities for future research and how this may impact clinical practice.

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