Successful Steroid Therapy for Cefdinir-induced Acute Tubulointerstitial Nephritis with Progressive Renal Failure.

A 36-year-old primigravida female from a birthing center was referred for elevated blood pressure to the hospital two days after normal spontaneous vaginal delivery with nausea, vomiting, and diarrhea. During this two-day period, she was experiencing persistent vaginal bleeding and lower abdominal pains for which she took six doses of 600 mg ibuprofen. Further laboratory evaluation reflected leukocytosis, anemia, thrombocytopenia, elevation of liver enzymes, and renal failure with hyperkalemia requiring emergent hemodialysis once in the Medical Intensive Care Unit (MICU). She was diagnosed with HELLP syndrome with underlying preeclampsia. A week later, due to hypertension controlled with medications and nonoliguric renal failure with no active urine sediments, a renal biopsy was indicated to direct management. The renal biopsy supported the diagnosis of diffuse severe acute tubulointerstitial nephritis with hypereosinophilia and thin basement membrane nephropathy (see figures). She was subsequently treated with high-dose steroids which resulted in the normalization of blood pressures and renal function returning to baseline. We report the first case of acute tubulointerstitial nephritis in an individual with thin basement membrane nephropathy secondary to postpartum complications.

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Pathological evidence of rhabdomyolysis-induced acute tubulointerstitial nephritis accompanying Legionella pneumophila pneumonia: Figure 1

Journal of Clinical Pathology ◽

10.1136/jcp.2008.057000 ◽

2008 ◽

Vol 61 (9) ◽

pp. 1062-1063 ◽

Cited By ~ 9

Author(s):

C Shimura ◽

T Saraya ◽

H Wada ◽

S Takata ◽

S Mikura ◽

...

Keyword(s):

Renal Failure ◽

Renal Function ◽

Legionella Pneumophila ◽

Tubulointerstitial Nephritis ◽

Antimicrobial Treatment ◽

Chest Roentgenogram ◽

Muscle Dysfunction ◽

High Grade ◽

High Grade Fever ◽

Acute Tubulointerstitial Nephritis

A case of Legionella pneumophila pneumonia with rhabdomyolysis-induced acute tubulointerstitial nephritis (ATIN) and prolonged renal dysfunction is presented. The patient was a 54-year-old man, admitted with high-grade fever, ataxia and muscle dysfunction; chest roentgenogram showed multilobular infiltrations. L pneumophila was detected in his sputum and urine, by PCR and by culture, and L pneumophila pneumonia was diagnosed. Despite antimicrobial treatment, he developed renal failure and rhabdomyolysis. Renal biopsy showed the presence of myoglobin casts that occluded the distal tubuli and tubulointerstitial nephritis, leading to the diagnosis of rhabdomyolysis-induced ATIN. Renal function subsequently normalised, and he was discharged. This is believed to be the first pathological evidence of involvement of rhabdomyolysis in legionellosis-associated ATIN.

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Acute Tubulointerstitial Nephritis with Renal Failure Complicated by Typhoid Fever

Journal of the Korean Society of Pediatric Nephrology ◽

10.3339/jkspn.2010.14.2.236 ◽

2010 ◽

Vol 14 (2) ◽

pp. 236 ◽

Cited By ~ 2

Author(s):

Jung Min Oh ◽

Na Ra Lee ◽

Hyung Eun Yim ◽

Kee Hwan Yoo ◽

Woon Yong Jeong ◽

...

Keyword(s):

Renal Failure ◽

Typhoid Fever ◽

Tubulointerstitial Nephritis ◽

Acute Tubulointerstitial Nephritis

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Acute tubulointerstitial nephritis and polyclonal hypergammaglobulinaemia: Which is the culprit?

Clinics and Practice ◽

10.4081/cp.2018.1065 ◽

2018 ◽

Vol 8 (4) ◽

Cited By ~ 1

Author(s):

Ana E. Sirvent ◽

Ricardo Enríquez ◽

Tania Muci ◽

Francisco Javier Ardoy-Ibañez ◽

Isabel Millán ◽

...

Keyword(s):

Renal Failure ◽

Renal Function ◽

Serum Creatinine ◽

Renal Biopsy ◽

Proton Pump ◽

Tubulointerstitial Nephritis ◽

Systemic Disease ◽

Acute Tubulointerstitial Nephritis ◽

Long Period

Proton pump inhibitors (PPIs) are among the most frequent implicated drugs in acute tubulointerstitial nephritis (ATIN), nevertheless it is important to report cases with atypical profiles. A 80-year-old female, exposed during 34 months to omeprazole, presented with polyclonal hypergammaglobulinaemia and renal failure. After stopping omeprazole there was a partial improvement in serum creatinine and IgG. Renal biopsy revealed ATIN; immunohistochemistry for IgG4 was negative. Treatment with steroids and mycophenolate sodium improved renal function and normalized immunoglobulins. The lack of data of other entities and the patient’s evolution strongly point omeprazole as the culprit. After 27 months of follow-up, she remains clinical and analytically stable. ATIN caused by PPIs may appear after a long period of exposure and may be accompanied by analytical anomalies that simulate a systemic disease.

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Case Review of lgG4-Related Disease Patient with Combined Tubulointerstitial Nephritis and Membranous Nephropathy Coexisting with Cholangiocarcinoma: Case Report

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2020.11.10685 ◽

2020 ◽

Vol 103 (11) ◽

pp. 1230-1235

Keyword(s):

Renal Failure ◽

Membranous Nephropathy ◽

Tubulointerstitial Nephritis ◽

Disease Patient ◽

Case Review ◽

Related Disease ◽

Phospholipase A2 Receptor ◽

Wide Range ◽

Serum Igg4 ◽

Secondary Membranous Nephropathy

Immunoglobulin G4-related disease (IgG4-RD) has recently been recognized as an autoimmune disorder involving multiple organs. The kidney is a represented organ with a wide range of renal manifestations. The authors report a case of an 83-year-old Thai male with combined IgG4 tubulointerstitial nephritis and membranous nephropathy coexisting with cholangiocarcinoma. The patient presented with proteinuria, acute renal failure, eosinophilia, hypocomplementemia, and high serum IgG4 concentration. The diagnosis was IgG 4-related tubulointerstitial nephritis and membranous nephropathy on renal biopsy, with negative immunohistochemistry for anti-phospholipase A2 receptor antibodies. Magnetic resonance imaging (MRI) abdomen showed two wedge shaped arterial enhancing lesions of liver. Liver biopsy revealed adenocarcinoma, compatible with cholangiocarcinoma. Proteinuria and renal failure were resolved with initial steroid treatment. Meanwhile, IgG4-related membranous nephropathy should be considered in the differential diagnosis for patients with proteinuria. Potentially, IgG4-RD may be rarely associated with carcinoma development. However, further studies are recommended to ratify and confirm the association between IgG4-RD and incidence of malignancies. Keywords: IgG4-related disease, Membranous nephropathy, Secondary membranous nephropathy, Tubulointerstitial nephritis, Cholangiocarcinoma

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Acute tubulointerstitial nephritis in children and chronic kidney disease

Archives de Pédiatrie ◽

10.1016/j.arcped.2019.05.002 ◽

2019 ◽

Vol 26 (5) ◽

pp. 290-294 ◽

Cited By ~ 3

Author(s):

S. Clavé ◽

C. Rousset-Rouvière ◽

L. Daniel ◽

M. Tsimaratos

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Tubulointerstitial Nephritis ◽

Acute Tubulointerstitial Nephritis

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Urinary Cytokines Reflect Renal Inflammation in Acute Tubulointerstitial Nephritis: A Multiplex Bead-Based Assay Assessment

Journal of Clinical Medicine ◽

10.3390/jcm10132986 ◽

2021 ◽

Vol 10 (13) ◽

pp. 2986

Author(s):

Laura Martinez Valenzuela ◽

Juliana Draibe ◽

Oriol Bestard ◽

Xavier Fulladosa ◽

Francisco Gómez-Preciado ◽

...

Keyword(s):

Tubulointerstitial Nephritis ◽

Urinary Concentration ◽

Blood Eosinophil ◽

Acute Tubulointerstitial Nephritis ◽

Luminex Assay ◽

Non Invasive ◽

Urinary Levels ◽

Histological Data ◽

The Individual ◽

Multiplex Bead

Background: Acute tubulointerstitial nephritis (ATIN) diagnosis lays on histological assessment through a kidney biopsy, given the absence of accurate non-invasive biomarkers. The aim of this study was to evaluate the accuracy of different urinary inflammation-related cytokines for the diagnostic of ATIN and its distinction from acute tubular necrosis (ATN). Methods: We included 33 patients (ATIN (n = 21), ATN (n = 12)), and 6 healthy controls (HC). We determined the urinary levels of 10 inflammation-related cytokines using a multiplex bead-based Luminex assay at the time of biopsy and after therapy, and registered main clinical, analytical and histological data. Results: At the time of biopsy, urinary levels of I-TAC/CXCL11, CXCL10, IL-6, TNFα and MCP-1 were significantly higher in ATIN compared to HC. A positive correlation between the extent of the tubulointerstitial cellular infiltrates in kidney biopsies and the urinary concentration of I-TAC/CXCL11, MIG/CXCL9, CXCL10, IL17, IFNα, MCP1 and EGF was observed. Notably, I-TAC/CXCL11, IL-6 and MCP-1 were significantly higher in ATIN than in ATN, with I-TAC/CXCL11 as the best discriminative classifier AUC (0.77, 95% CI 0.57–0.95, p = 0.02). A combinatory model of these three urinary cytokines increased the accuracy in the distinction of ATIN/ATN compared to the individual biomarkers. The best model resulted when combining the three cytokines with blood eosinophil and urinary leukocyte counts (LR = 9.76). Follow-up samples from 11ATIN patients showed a significant decrease in I-TAC/CXCL11, MIG/CXCL9 and CXCL10 levels. Conclusions: Urinary I-TAC/CXCL11, CXCL10, IL6 and MCP-1 levels accurately distinguish patients developing ATIN from ATN and healthy individuals and may serve as novel non-invasive biomarkers in this disease.

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INF2 p.Arg214Cys mutation in a Chinese family with rapidly progressive renal failure and follow-up of renal transplantation: case report and literature review

BMC Nephrology ◽

10.1186/s12882-021-02254-9 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Wenbo Zhao ◽

Xinxin Ma ◽

Xiaohao Zhang ◽

Dan Luo ◽

Jun Zhang ◽

...

Keyword(s):

Renal Failure ◽

Renal Disease ◽

Autosomal Dominant ◽

Mutational Analysis ◽

Elevated Serum ◽

Chinese Family ◽

Progressive Renal Failure ◽

Rapidly Progressive Renal Failure ◽

Stage Renal Disease ◽

End Stage

Abstract Background Heterozygous mutations in the inverted formin 2 (INF2) gene are related to secondary focal segmental glomerulosclerosis (FSGS), a rare secondary disease associated with rapidly progressive renal failure. Case presentation We report a patient with familial autosomal INF2 mutation manifesting nephritic syndromes and elevated serum creatinine levels. Mutational analysis revealed an autosomal dominant (AD) inheritance pattern and a mutation in exon 4 (p.Arg214Cys) of INF2 as the likely cause, which has not been previously described in an Asian family. The patient progressed to end-stage renal disease (ESRD) and received hemodialysis. His mother had undergone renal transplant 3 years earlier, and his grandmother had carried the p.Arg214Cys mutation for more than 80 years without any sign of renal dysfunction. Conclusions This is the first report to identify an association between a familial autosomal dominant INF2 p.Arg214Cys mutation and rapidly progressive renal disease in an Asian family. INF2 mutation analysis should not be restricted to individuals without family history of FSGS, rather it should also be performed on individuals for whom drug-based therapies are not effective. In this case, kidney transplant is an effective alternative.

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