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Praga M, Caravaca-Fontán F. Should Corticosteroids be Used To Treat Biopsy-Proven Drug-Induced Acute Interstitial Nephritis?: COMMENTARY. KIDNEY360 2022; 3:1314-1316. [PMID: 36178452 PMCID: PMC9416843 DOI: 10.34067/kid.0008342021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 01/20/2022] [Indexed: 01/11/2023]
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Azukaitis K, Besusparis J, Laurinavicius A, Jankauskiene A. Case Report: SARS-CoV-2 Associated Acute Interstitial Nephritis in an Adolescent. Front Pediatr 2022; 10:861539. [PMID: 35498789 PMCID: PMC9047909 DOI: 10.3389/fped.2022.861539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/18/2022] [Indexed: 12/03/2022] Open
Abstract
Acute interstitial nephritis (AIN) has been recently recognized as one of the infrequent kidney involvement phenotypes among adult patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Although SARS-CoV-2 associated intrinsic kidney disease has been scarcely reported in children, only one case of AIN temporally associated with the infection has been described in the pediatric population so far. We presented a case of a 12-year old boy who presented with fatigue, anorexia, and polydipsia following an RT-PCR that confirmed SARS-CoV-2 infection seven weeks prior to admission. Initial workup revealed increased serum creatinine (235 μmol/L), glucosuria, low-molecular-weight proteinuria, mild leukocyturia, and microhematuria with hyaline and granular casts on microscopy. Antibodies against the SARS-CoV-2 S protein receptor-binding domain confirmed prior infection with high titers. Kidney biopsy showed diffuse active interstitial nephritis with negative immunofluorescence and positive immunohistochemistry for SARS-CoV-2 in the inflammatory cells within the interstitium. Electron microscopy revealed several SARS-CoV-2-like particles. Kidney function continued to deteriorate despite several days of supportive therapy only (peak serum creatinine 272 μmol/L); thus, treatment with methylprednisolone pulse-dose therapy was initiated and was followed by oral prednisolone with gradual tapering. Kidney function completely recovered after 3 weeks post-discharge and remained normal after 11 weeks of follow-up (last estimated glomerular filtration rate 106 ml/min/1.73 m2) with only residual microhematuria. Our case adds to the emerging evidence of SARS-CoV-2 as a potential etiological agent of AIN in children and also suggests that interstitial kidney injury may result from secondary inflammatory damage. Epidemiological history, serologic testing, and SARS-CoV-2 detection in biopsy should be considered in the work-up of children with AIN of unknown etiology.
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Mira FS, Costa Carvalho J, de Almeida PA, Pimenta AC, Alen Coutinho I, Figueiredo C, Rodrigues L, Sousa V, Ferreira E, Pinto H, Escada L, Galvão A, Alves R. A Case of Acute Interstitial Nephritis After Two Doses of the BNT162b2 SARS-CoV-2 Vaccine. Int J Nephrol Renovasc Dis 2021; 14:421-426. [PMID: 34887676 PMCID: PMC8650829 DOI: 10.2147/ijnrd.s345898] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 11/25/2021] [Indexed: 01/13/2023] Open
Abstract
Background The development of vaccines to prevent COVID-19 breakouts came with highly positive results but some unexpected side effects. Rare side effects have been seen with the BNT162b2 SARS-CoV 2 vaccine. Case Presentation We present the case of a 45-year-old female patient who developed an acute kidney injury needing urgent hemodialysis one week after the second administration of the BNT162b2 SARS-CoV 2 vaccine. She developed a macular rash on her lower limbs and palms as well. A kidney biopsy was performed 10 days after vaccine inoculation, diagnosing acute interstitial nephritis and acute tubular necrosis with cellular casts. The patient was treated with three corticosteroid pulses followed by daily prednisolone. We witnessed clinical improvement 4 days after the initial corticosteroid treatment with progressive recovery of kidney function and hemodialysis withdrawal. After 2 weeks, the patient had recovered her kidney function. Immunophenotyping was performed, diagnosing a hypersensitivity to the vaccine and the polyethylene glycol excipient. Conclusion Patients may develop acute reactions to vaccines. In this case, symptoms seem to correlate significantly with its inoculation and, although this case had a favourable outcome, these side effects must be made aware for clinicians and patients.
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Jahir T, Hossain SMS, Risal R, Schmidt M, Enriquez D, Bagum M. Cocaine Hurts Your Kidneys Too: A Rare Case of Acute Interstitial Nephritis Caused by Cocaine Abuse. Cureus 2021; 13:e19236. [PMID: 34877213 PMCID: PMC8642135 DOI: 10.7759/cureus.19236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 01/06/2023] Open
Abstract
Cocaine is a powerfully addictive recreational drug that is extracted from the leaves of the Erythroxylon coca plant native to Central and South America. It is a widely abused substance, despite being banned since the early 19th century due to fatalities. Cocaine may result in acute kidney injury (AKI) by different mechanisms, but acute interstitial nephritis (AIN) is scarcely recognized as the cause of acute kidney injury (AKI). Here, we present a case of AKI from both AIN and acute tubular necrosis (ATN) following cocaine insufflation. The purpose of this article is to review the rare but significant association of AIN associated with cocaine use. The nature of the treatment of cocaine-related kidney disease may differ from other causes of acute kidney insult. Prompt recognition of the underlying cause of renal dysfunction is vital for this group of patients to prevent the rapid deterioration of renal function.
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Markóth C, File I, Szász R, Bidiga L, Balla J, Mátyus J. Ibrutinib-induced acute kidney injury via interstitial nephritis. Ren Fail 2021; 43:335-339. [PMID: 33567947 PMCID: PMC7889134 DOI: 10.1080/0886022x.2021.1874985] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/07/2021] [Accepted: 01/07/2021] [Indexed: 11/27/2022] Open
Abstract
The introduction of Bruton's tyrosine kinase inhibitor ibrutinib has made a significant progress in the treatment of chronic lymphocytic leukemia and other B-cell malignancies. Due to the reduction of cytokine release, it is effective in chronic graft-versus-host disease, and its use has also been suggested in autoimmune diseases and in prevention of COVID-19-associated lung damage. Despite this effect on the immune response, we report a severe hypersensitivity reaction in a 76-year-old male patient diagnosed with prolymphocytic leukemia. Four weeks after the ibrutinib start, non-oliguric acute kidney injury with proteinuria and microscopic hematuria developed and that was accompanied by lower limb purpuras and paresthesia. Renal biopsy revealed acute interstitial nephritis. Employing 1 mg/kg methylprednisolone administration, serum creatinine decreased from 365 μmol/L to 125 μmol/L at 11 days and the proteinuria-hematuria as well as the purpura, paresthesia resolved. Three months later at stabile eGFR of 56 ml/min/1.73 m2 methylprednisolone was withdrawn and a rituximab-venetoclax treatment was initiated without side effects. We conclude that despite the beneficial effect on cytokines response in Th1 direction, ibrutinib can cause acute interstitial nephritis. Early detection, discontinuation of ibrutinib, glucocorticoid administration may help to better preserve renal function, thereby lowering the risk of potential subsequent kidney injury.
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Seethapathy H, Herrmann SM, Sise ME. Immune Checkpoint Inhibitors and Kidney Toxicity: Advances in Diagnosis and Management. Kidney Med 2021; 3:1074-1081. [PMID: 34939017 PMCID: PMC8664750 DOI: 10.1016/j.xkme.2021.08.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Immune checkpoint inhibitors are now approved for more than 50 indications, and increasing numbers of patients with advanced cancer are receiving immunotherapy. Immune-related adverse events that result from checkpoint inhibitors can affect any organ system. The most common kidney side effect is acute kidney injury, typically caused by acute interstitial nephritis. This review covers the most recent advances in immune checkpoint inhibitor-induced acute kidney injury. The review focuses on the differences between checkpoint inhibitor classes in causing acute kidney injury and differentiating immune checkpoint inhibitor-induced kidney damage from other causes of acute kidney injury. We describe the appropriate use of a kidney biopsy in the diagnosis of acute kidney injury and highlight the need for identification of noninvasive diagnostic and predictive biomarkers of immune checkpoint inhibitor-induced acute kidney injury. In the treatment section, approaches to corticosteroid use and the risks and benefits of rechallenging patients who experience acute kidney injury are debated. We also clarify the long-term adverse effects of immune checkpoint inhibitors on kidney function and the risk of chronic kidney disease in cancer survivors.
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Kanduri SR, Velez JCQ. Is Rechallenge Appropriate in Patients that Develop Immune Checkpoint Inhibitor-Associated AKI?: CON. KIDNEY360 2021; 3:803-805. [PMID: 36128485 PMCID: PMC9438430 DOI: 10.34067/kid.0003902021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/17/2021] [Indexed: 01/10/2023]
Abstract
This is an Early Access article. Please select the PDF button, above, to view it.
Be sure to also read the PRO: 10.34067/KID.0003962021 and the COMMENTARY 10.34067/KID.0005592021
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Jethwani P, Shirali AC. Gene Expression Profiling in Kidney Transplant Recipients on Immune Checkpoint Inhibitors: More than Meets the Eye. Clin J Am Soc Nephrol 2021; 16:1315-1317. [PMID: 34497109 PMCID: PMC8729569 DOI: 10.2215/cjn.09860721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Yang R, Moosavi L, Eppanapally S, Aboeed A, Munoz A. Acute Interstitial Nephritis: A Rare and Unusual Side Effect of Omalizumab. J Investig Med High Impact Case Rep 2021; 8:2324709620946890. [PMID: 32744093 PMCID: PMC7412888 DOI: 10.1177/2324709620946890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
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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Tuma J. [CME Sonography 99/Answers: Kidney Echo Changes]. PRAXIS 2021; 110:510-511. [PMID: 34231382 DOI: 10.1024/1661-8157/a003676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
CME Sonography 99/Answers: Kidney Echo Changes Abstract. Normal kidneys have a smooth contour, kidney length 9-12 cm, volume 90-180 ml/1.73 m2 body surface, parenchyma width 13-18 mm and an echogenicity of the cortex which is hypoechoic compared to the liver and spleen, as well as medullary pyramids, which are again hypoechoic compared to the cortex. Digital ultrasound images enable the echogenicity to be measured between 0 (black) and 255 (white). A normal quotient between the echogenicity of the liver and the renal cortex is 1.0-1.4. A normal quotient between the spleen and the renal cortex is> 1.0. The normal quotient between the renal cortex and the renal medulla is> 1.0. In diffuse renal parenchyma diseases, changes in echogenicity are observed. There are kidneys with increased echogenicity of the cortex and a ratio to liver and spleen of <1.0 and kidneys with hyperechoic renal medulla and the ratio between renal cortex and renal medulla <1.0.
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Huang L, Liang S, Dong J, Fan W, Zeng C, Zhang T, Cheng S, Ge Y. Prognosis of severe drug-induced acute interstitial nephritis requiring renal replacement therapy. Ren Fail 2021; 43:1020-1027. [PMID: 34187299 PMCID: PMC8253213 DOI: 10.1080/0886022x.2021.1942914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective Drug-induced acute interstitial nephritis (DAIN) is often associated with improved outcomes, whereas some patients may still progress to chronic kidney disease (CKD). The aim of this study was to evaluate the prognosis of patients with severe DAIN requiring renal replacement therapy (RRT) at baseline, and to explore the risk factors of progression to CKD. Methods We performed a retrospective study of patients with severe DAIN confirmed by renal biopsies in our center over a 10 years period, all the patients received RRT at presentation. The clinical and pathological characteristics at baseline were recorded, and the outcomes (renal function recovered or progressed to CKD) during follow-ups were also evaluated. Univariate and multivariate logistic regression analysis were performed to identify the independent risk factors of progression to CKD. Results Seventy-two patients who met the inclusion criteria were enrolled, 13 patients (18.0%) progressed to CKD (GFR < 60 ml/min/1.73 m2) after at least 6 months of follow-up, the remaining 59 patients achieved a favorable renal function recovery. Compared with patients who achieved renal function recovery (recovery group), the patients progressed to CKD (progression group) were older and had longer interval from symptom onset to treatment with steroids. The peak serum cystatin C concentration was higher in progression group than recovery group. Higher score of interstitial fibrosis/tubular atrophy (IFTA) and more interstitial inflammatory cells infiltration were detected in renal tissue in progression group. According to multivariable analysis, higher peak cystatin C concentration (OR = 2.443, 95% CI 1.257, 4.746, p = 0.008), longer interval to treatment with corticosteroids (OR = 1.183, 95% CI 1.035, 1.352, p = 0.014) were independent risk factors of progression to CKD. The cutoff value of cystatin C concentration was 4.34 mg/L, at which the sensitivity and specificity were 76.9% and 89.3%, respectively; the cutoff value of interval to treatment with corticosteroids was 22.5 days, at which the sensitivity and specificity were 81.8% and 79.5%, respectively. Conclusion Renal function was reversible in majority of patients with severe DAIN requiring RRT when early identification and treatment. Higher peak cystatin C concentration and longer interval to treatment with corticosteroids associated with worse renal prognosis.
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Liu AC, Chang Y, Zuckerman JE, Kalantar-Zadeh K, Ghobry LM, Hanna RM. Ibuprofen-associated minimal change disease and acute interstitial nephritis with possibly linked membranous glomerulonephritis. SAGE Open Med Case Rep 2021; 9:2050313X211025145. [PMID: 34221404 PMCID: PMC8221701 DOI: 10.1177/2050313x211025145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/25/2021] [Indexed: 11/30/2022] Open
Abstract
Non-steroidal anti-inflammatory drugs are not only potent analgesics and antipyretics but also nephrotoxins, and may cause electrolyte disarray. In addition to the commonly expected effects, including hyperkalemia, hyponatremia, acute renal injury, renal cortical necrosis, and volume retention, glomerular disease with or without nephrotic syndrome or nephritis can occur as well including after years of seemingly safe administration. Minimal change disease, secondary membranous glomerulonephritis, and acute interstitial nephritis are all reported glomerular lesions seen with non-steroidal anti-inflammatory use. We report a patient who used non-steroidal anti-inflammatory drugs for years without diabetes, chronic kidney disease, or proteinuria; he then developed severe nephrotic range proteinuria with 7 g of daily urinary protein excretion. Renal biopsy showed minimal change nephropathy, a likely secondary membranous glomerulonephritis, and acute interstitial nephritis present simultaneously in one biopsy. Cessation of non-steroidal anti-inflammatory drug use along with steroid treatment resulted in a moderate improvement in renal function, though residual impairment remained. Urine heavy metal screen returned with elevated levels of urine copper, but with normal ceruloplasmin level. Workup suggested that the elevated copper levels were due to cirrhosis from non-alcoholic fatty liver disease. The membranous glomerulonephritis is possibly linked to non-steroidal anti-inflammatory drug exposure, and possibly to heavy metal exposure, and is clinically and pathologically much less likely to be a primary membranous glomerulonephritis with negative serological markers.
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Inayat F, Bokhari SRA, Roberts L, Rosen RM. Cocaine-Induced Acute Interstitial Nephritis: A Comparative Review of 7 Cases. J Investig Med High Impact Case Rep 2021; 8:2324709620932450. [PMID: 32517516 PMCID: PMC7288801 DOI: 10.1177/2324709620932450] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Acute interstitial nephritis is a well-known cause of acute kidney injury, but
its association with cocaine use is extremely rare. In this article, we
chronicle the case of a patient who developed acute interstitial nephritis
secondary to cocaine insufflation. Furthermore, we conducted a systematic
literature search of MEDLINE, Cochrane, Embase, and Scopus databases regarding
cocaine-induced acute interstitial nephritis. A comprehensive review of the
search results yielded a total of 7 case reports only. The data on patient
characteristics, clinical features, biochemical profiles, treatment, and
outcomes were collected and analyzed. This paper illustrates that acute
interstitial nephritis may be added to the list of differentials in patients
with acute kidney injury and a history of cocaine use. The therapeutic approach
for cocaine-related kidney disease may be different than other etiologies
responsible for acute renal insult. Prompt recognition of this entity is crucial
because such patients may ultimately develop severe deterioration in renal
function.
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39
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Tuma J. [CME Sonography 99: Kidney Echo Changes]. PRAXIS 2021; 110:461-468. [PMID: 34107761 DOI: 10.1024/1661-8157/a003675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
CME Sonography 99: Kidney Echo Changes Abstract. Normal kidneys have a smooth contour, kidney length 9-12 cm, volume 90-180 ml/1.73 m2 body surface, parenchyma width 13-18 mm and an echogenicity of the cortex which is hypoechoic compared to the liver and spleen, as well as medullary pyramids, which are again hypoechoic compared to the cortex. Digital ultrasound images enable the echogenicity to be measured between 0 (black) and 255 (white). A normal quotient between the echogenicity of the liver and the renal cortex is 1.0-1.4. A normal quotient between the spleen and the renal cortex is >1.0. The normal quotient between the renal cortex and the renal medulla is >1.0. In diffuse renal parenchyma diseases, changes in echogenicity are observed. There are kidneys with increased echogenicity of the cortex and a ratio to liver and spleen of <1.0 and kidneys with hyperechoic renal medulla and the ratio between renal cortex and renal medulla <1.0.
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Oleas D, Bolufer M, Agraz I, Felip E, Muñoz E, Gabaldón A, Bury R, Espinel E, Serón D, García-Carro C, Soler MJ. Acute interstitial nephritis associated with immune checkpoint inhibitors: a single-centre experience. Clin Kidney J 2021; 14:1364-1370. [PMID: 34221369 PMCID: PMC8247740 DOI: 10.1093/ckj/sfaa008] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 01/03/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Checkpoint inhibitors (CPIs) are used to treat solid organ metastatic malignancies. They act by triggering a vigorous immune response against tumoural cells, preventing their proliferation and metastasis. However, this is not a selective response and can cause immune-related adverse events (irAEs). The kidney can potentially be damaged, with an incidence of irAEs of 1-4%. The most frequent type of toxicity described is acute interstitial nephritis (AIN). METHODS We conducted a study of patients with solid organ metastatic malignancies treated with immunotherapy who developed acute renal injury and underwent kidney biopsy in the last 14 months at the Vall d'Hebron University Hospital. RESULTS In all, 826 solid organ malignancies were treated with immunotherapy in our centre, 125 of them (15.1%) developed acute kidney injury (AKI), 23 (18.4% of AKI) visited the nephrology department and 8 underwent kidney biopsy. The most frequent malignancy was lung cancer, in five patients (62%), followed by two patients (25%) with melanoma and one patient (12%) with pancreatic cancer. Four patients (50%) had already received previous oncological therapy, and for the remaining four patients (50%), CPI was the first-line therapy. Five patients (62%) were treated with anti-programmed cell death protein 1, three patients (37%) received anti-programmed death ligand 1 and two (25%) patients were treated in combination with anti-cytotoxic T-lymphocyte antigen 4. The time between the start of CPI and the onset of the AKI ranged from 2 to 11 months. The most frequent urine findings were subnephrotic-range proteinuria, with a mean protein:creatinine ratio of 544 mg/g (standard deviation 147) and eosinophiluria. All patients were biopsied after being diagnosed with AIN. Three patients (37%) received treatment with pulses of methylprednisolone 250-500 mg/day and five patients (62%) received prednisone 1 mg/kg/day. Seven patients (87%) experienced recovery of kidney function and one patient (12%) progressed to chronic kidney disease. CONCLUSIONS We report on eight patients with CPI-related AIN diagnosed in the last 14 months at our centre. The novel immunotherapy treatment of metastatic solid organ malignancies carries a higher risk of irAEs. The kidney is one of the most commonly affected organs, frequently presenting as an AIN and exhibiting a favourable response to steroid treatment.
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Anupama BK, Sampat P, Gambhir HS. Nitrofurantoin-Associated Acute Granulomatous Interstitial Nephritis. J Investig Med High Impact Case Rep 2021; 9:23247096211001659. [PMID: 33733898 PMCID: PMC7983233 DOI: 10.1177/23247096211001659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We report the case of a 71-year-old female who was incidentally found to have
nonoliguric acute kidney injury on a routine workup for new-onset visual
hallucination. Further history revealed inadvertent usage of nitrofurantoin for
3 months for an anticipated urological procedure. Renal biopsy demonstrated
acute granulomatous interstitial nephritis. The renal function significantly
improved following discontinuation of nitrofurantoin and corticosteroid
administration. We highlight a rare association of nitrofurantoin with acute
granulomatous interstitial nephritis through this case report.
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Lichak BP, Lawal O, Polimera HV, Garg A, Kaur G. A Case of Cefepime-Induced Neurotoxicity: Renal Function Missing in Action. Cureus 2021; 13:e13368. [PMID: 33754096 PMCID: PMC7971718 DOI: 10.7759/cureus.13368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Cefepime is a renally excreted, fourth-generation cephalosporin used in the treatment of severe abdominal, skin, soft tissue, and urinary tract infections due to its broad-spectrum coverage. Cefepime-induced neurotoxicity is a rare but serious side effect that has increased in recent years likely due to increased antibiotic use, increased drug resistance, and increased symptom recognition. While decreased glomerular filtration rate is an important risk factor for developing elevated serum cefepime levels, recent literature has suggested that a significant proportion of patients with normal renal function can also develop neurotoxicity from cefepime. Here, we present a case of cefepime-induced neurotoxicity to demonstrate the importance of monitoring mental status changes in all patients being treated with cefepime.
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Lin JS, Mamlouk O, Selamet U, Tchakarov A, Glass WF, Sheth RA, Layman RM, Dadu R, Abdelwahab N, Abdelrahim M, Diab A, Yee C, Abudayyeh A. Infliximab for the treatment of patients with checkpoint inhibitor-associated acute tubular interstitial nephritis. Oncoimmunology 2021; 10:1877415. [PMID: 33643693 PMCID: PMC7872057 DOI: 10.1080/2162402x.2021.1877415] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Acute tubular interstitial nephritis (ATIN) is the most frequently reported pathology in patients with checkpoint inhibitor (CPI) induced acute kidney injury (AKI). Glucocorticoid (GC) therapy and discontinuation of CPI are the mainstay of treatment to prevent permanent renal dysfunction and dialysis. However, less than 50% of patients have complete kidney recovery and relapse of ATIN can occur. Infliximab is effective in treating other immune-related adverse events but its use for the treatment of CPI-ATIN is not well established. We report the first retrospective study examining the steroid-sparing potential of infliximab in achieving durable and complete renal recovery for patients with CPI-ATIN. Data were collected from medical records of patients diagnosed with CPI-AKI with a kidney biopsy or clinical diagnosis of ATIN that was managed with GC and infliximab. Infliximab-containing regimens were used to treat 10 patients with CPI-ATIN. Four patients relapsing after GC therapy achieved durable and complete renal recovery, four patients experienced partial renal recovery, and two patients showed no improvement in kidney function. This is the first study evaluating clinical outcomes using an infliximab-containing regimen for treatment of relapsed CPI-ATIN in patients or patients failing to achieve complete response after primary therapy. Our data suggest that infliximab may be a treatment option for achieving durable and complete renal recovery in this patient population and represents a potential steroid-sparing strategy in challenging cases of CPI-ATIN. Rigorous clinical studies are warranted to evaluate the risk-benefit analysis for infliximab usage in CPI-ATIN patients.
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Mulroy M, Ghafouri S, Sisk A, Ribas A, Goshtaseb R, Cherry G, Shen J. Acute interstitial nephritis and PR3-ANCA following reintroduction of pembrolizumab: a case report. Immunotherapy 2021; 13:283-288. [PMID: 33397120 DOI: 10.2217/imt-2020-0223] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Renal toxicity from immune checkpoint inhibitors (ICIs) is an increasingly recognized cause of acute kidney injury among patients with cancer. ICI-associated acute kidney injuries typically present as acute interstitial nephritis and the timing of onset is highly variable. Herein, we present a case of a patient with relapsed metastatic melanoma previously treated with pembrolizumab who developed grade 3 immune-related renal toxicity after reintroduction of the same ICI, secondary to acute interstitial nephritis with accompanying high PR3-antineutrophil cytoplasmic antibody titer. The patient improved after steroid treatment and discontinuation of pembrolizumab. This case highlights the importance of not excluding ICI-related nephrotoxicity as a possible cause of renal failure, including in those who previously tolerated ICI treatment, since it is a treatable entity.
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Athavale A, Morris J, Jardine M, Gallagher M, Sen S, Ritchie A, Wang AY. Acute interstitial nephritis and nephrogenic diabetes insipidus following treatment with sulfamethoxazole-trimethoprim and temozolomide. Nephrology (Carlton) 2020; 26:12-14. [PMID: 32935422 DOI: 10.1111/nep.13783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/07/2020] [Accepted: 09/10/2020] [Indexed: 11/29/2022]
Abstract
We report a case of acute interstitial nephritis with associated nephrogenic diabetes insipidus in a patient treated with temozolomide and sulfamethoxazole-trimethoprim for glioblastoma multiforme. Kidney biopsy demonstrated focal tubulointerstitial change with tubular dilatation, epithelial change and interstitial inflammation. The patient's kidney function improved with cessation of sulfamethoxazole-trimethoprim and treatment with hydrochlorothiazide for nephrogenic diabetes insipidus. Recommencement of temozolomide did not result in further deterioration in kidney function. In this case report, we discuss the novel association between sulfamethoxazole-trimethoprim-induced acute interstitial nephritis and nephrogenic diabetes insipidus, and suggest possible mechanisms involved.
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Herrmann SM, Alexander MP, Romero MF, Zand L. Renal Tubular Acidosis and Immune Checkpoint Inhibitor Therapy: An Immune-Related Adverse Event of PD-1 Inhibitor-A Report of 3 Cases. Kidney Med 2020; 2:657-662. [PMID: 33089143 PMCID: PMC7568062 DOI: 10.1016/j.xkme.2020.05.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The main cause of acute kidney injury in patients receiving immune checkpoint inhibitors (ICIs) is acute interstitial nephritis. However, as their use continues to increase, other kidney manifestations are being described. We report 3 cases of patients treated with ICIs who developed predominantly electrolyte disorders secondary to renal tubular acidosis as an immune-related adverse event and discuss the potential mechanism. Nongap acidosis in combination with hypokalemia should raise suspicion for distal renal tubular acidosis in patients treated with ICIs.
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Incidence and Clinical Features of Immune-Related Acute Kidney Injury in Patients Receiving Programmed Cell Death Ligand-1 Inhibitors. Kidney Int Rep 2020; 5:1700-1705. [PMID: 33102962 PMCID: PMC7569697 DOI: 10.1016/j.ekir.2020.07.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/21/2020] [Accepted: 07/14/2020] [Indexed: 01/14/2023] Open
Abstract
Background Programmed cell death receptor ligand 1 (PD-L1) inhibitors are immune checkpoint inhibitors (ICIs) with a side effect profile that may differ from other classes of ICIs such as those directed against cytotoxic T-lymphocyte−associated protein 4 (CTLA-4) and programmed cell death 1 receptor (PD-1). Being the more recently approved class of checkpoint inhibitors, there are no studies investigating the frequency, etiology and predictors of acute kidney injury (AKI) in patients receiving PD-L1 inhibitors. Methods This was a retrospective cohort study of patients who received PD-L1 inhibitors during 2017 to 2018 in our healthcare system. AKI was defined by a ≥1.5-fold rise in serum creatinine from baseline. The etiology of all cases of sustained AKI (lasting >48 hours) and clinical course were determined by review of electronic health records. Results The final analysis included 599 patients. Within 12 months of ICI initiation, 104 patients (17%) experienced AKI, and 36 (6%) experienced sustained AKI; however, only 5 (<1%) experienced suspected PD-L1–related AKI. The PD-L1–related AKI occurred a median of 99 days after starting therapy. All patients concurrently received another medication known to cause acute interstitial nephritis (proton pump inhibitors, nonsteroidal anti-inflammatory drugs, or antibiotics) at the time of the suspected PDL1-related AKI. Conclusion Although AKI is common in patients receiving PD-L1 therapy, the incidence of suspected PD-L1–related AKI is low (<1%) and may be less common when compared to other classes of ICIs. This cohort provides further validation that other drugs associated with acute interstitial nephritis may be involved in the pathogenesis of ICI-related AKI.
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Sanwal C, Kaldas A, Surani S, Bailey M. Rifampin-Induced Acute Intravascular Hemolysis Leading to Heme Pigment-Related Kidney Injury. Cureus 2020; 12:e9120. [PMID: 32789061 PMCID: PMC7417115 DOI: 10.7759/cureus.9120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Rifampin-induced acute kidney injury is very rare. Most cases of acute renal injury from rifampin use are related to acute tubular necrosis and acute interstitial nephritis. In this case report, we detail a unique presentation of rifampin-associated acute intravascular hemolysis and subsequent tubular injury in a tuberculosis patient. The patient had presented to the hospital with acute kidney injury and oliguria from intravascular volume depletion secondary to intractable vomiting. The patient had stopped taking his antituberculosis medications two weeks before hospitalization. At the time of hospital admission, his antituberculosis regimen of rifampin and isoniazid was reinstituted. Within four days of initiation of rifampin, he developed acute hemolytic anemia. His kidney biopsy revealed hemoglobin pigment deposition in the kidney tubules. Rifampin was discontinued, and he received a total of eight hemodialysis treatments spanning over 17 days. Subsequently, after discontinuing rifampin, his anemia and oliguria resolved with renal function markedly improved to near normal baseline levels. This case report also offers a review of known mechanisms of rifampin-induced acute hemolysis and acute renal failure, along with a discussion of contemporary literature.
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Tuma J, Neugebauer F, Rohacek M, Serra A. [Renal Monomorphology in COVID-19 with Acute Renal Insufficiency]. PRAXIS 2020; 109:731-735. [PMID: 32469263 DOI: 10.1024/1661-8157/a003526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Renal Monomorphology in COVID-19 with Acute Renal Insufficiency Abstract. A 78-year-old ventilator-dependent COVID-19 patient developed severe renal failure with an estimated glomerular filtration rate of 20 ml/min per 1.73 m2 and nephrotic proteinuria. Sonography showed echo-dense and enlarged kidneys with high resistance indices (>0.8). Echocontrast sonography showed a delayed renal perfusion. In the further course of the disease renal function recovered, kidney size decreased and the renal perfusion normalized. An acute COVID-19-associated interstitial nephritis is postulated.
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Perez-Gomez MV, Sanchez-Niño MD, Ortiz A. Megalin/lipoprotein receptor-related protein 2 autoimmunity and kidney disease. Clin Kidney J 2020; 13:281-286. [PMID: 32701075 PMCID: PMC7367110 DOI: 10.1093/ckj/sfz171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
In this issue of Clinical Kidney Journal, Gamayo et al. describe two cases of anti-low-density lipoprotein receptor-related protein 2 (LRP2) nephropathy. This is a recently described entity that has features of both tubulointerstitial disease and segmental membranous nephropathy. The originality of the present report consists of the association of a disease thought to be rare (only 13 in prior described patients, 11 in the past year) with B-cell lymphoproliferative disease. Together with the finding of a third case among 224 elderly patients studied, this raises the issue of the underdiagnoses of LRP2 nephropathy, on top of the potential association to B-cell malignancy. We now put these findings in context within the wider frame of autoimmunity against megalin/LRP2 and related antigens such as Fx1A and CD69.
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