1
|
El-Husseiny Moustafa F, Nagy E, Elwasif SM, Sobh M. Karyomegalic interstitial nephritis as a rare cause of kidney graft dysfunction: case report and review of literature. BMC Nephrol 2023; 24:137. [PMID: 37208636 DOI: 10.1186/s12882-023-03185-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 04/27/2023] [Indexed: 05/21/2023] Open
Abstract
Karyomegalic interstitial nephritis (KIN) is a rare cause of chronic interstitial nephritis characterized by enlarged renal tubular epithelial nuclei. The first case of KIN reported in a kidney graft was in 2019. Here, we report the first case of KIN in 2 brothers receiving kidneys from 2 different unrelated living donors. A male kidney transplant recipient with focal segmental glomerulosclerosis as the original kidney disease presented with graft impairment and proteinuria, and graft biopsy revealed KIN. This patient had a brother who was also a kidney transplant recipient and had one episode of graft impairment and was diagnosed with KIN as well.
Collapse
Affiliation(s)
| | - Eman Nagy
- Mansoura Nephrology and Dialysis Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, El-Gomhuria Street, 35516, Mansoura, Egypt.
| | - Salwa Mahmoud Elwasif
- Urology and Nephrology Center, Faculty of Medicine, Mansoura University, 35516, Mansoura, Egypt
| | - Mohamed Sobh
- Urology and Nephrology Center, Faculty of Medicine, Mansoura University, 35516, Mansoura, Egypt
| |
Collapse
|
2
|
Wang H, Li K, Xiao R, Xu L, Zhen J, Wang R, Sun J. Heterozygous Variants in a Patient with Karyomegalic Interstitial Nephritis. Nephron Clin Pract 2022; 147:223-228. [PMID: 35896079 DOI: 10.1159/000525445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 05/30/2022] [Indexed: 11/19/2022] Open
Abstract
Karyomegalic interstitial nephritis (KIN) is a rare kidney disease marked by large tubular nuclei, interstitial inflammation, tubular atrophy, and interstitial fibrosis. The current study presented the case of a 39-year-old man with deteriorating kidney function and a serum creatinine level of 2.08 mg/dL. The renal biopsy revealed that the main pathological features of renal tubular epithelial cells were obvious enlargement, irregular shape, and hyperchromatic nuclei. The genetic analysis of the patient revealed two heterozygous variants in the FAN1 gene, c.2485c>T, and c.2928dupT, located in exons 10 and 13, respectively. A diagnosis of KIN was rendered. The two variations of the proband are identified in separate alleles from the father and mother, respectively, according to his family's sequencing. This phenotype is consistent with an autosomal recessive pattern of inheritance. The patient was treated with the Chinese patent medicine Niaoduqing Particles. After 38 months of follow-up, renal function was barely changed with a serum creatinine of 1.73 mg/dL.
Collapse
Affiliation(s)
- Haiping Wang
- Department of Nephrology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Kan Li
- Department of Central Sterile Supply, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Rui Xiao
- Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Liang Xu
- Department of Nephrology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Junhui Zhen
- Department of Pathology, Shandong University, Jinan, China
| | - Rong Wang
- Department of Nephrology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Jing Sun
- Department of Nephrology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.,Cheeloo College of Medicine, Shandong University, Jinan, China
| |
Collapse
|
3
|
Wang Z, Ni X, Zhu S, Yue S. IgA Nephropathy Concomitant With Karyomegalic Interstitial Nephritis. Am J Med Sci 2020; 360:287-292. [PMID: 32387117 DOI: 10.1016/j.amjms.2020.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 03/27/2020] [Accepted: 04/09/2020] [Indexed: 11/29/2022]
Abstract
Immunoglobulin A (IgA) nephropathy is one of the most common glomerulonephritis characterized by the deposition of IgA in glomerular mesangium. Karyomegalic interstitial nephritis (KIN) is a rare interstitial nephritis with potential hereditary factors. IgA nephropathy concomitant with KIN has not yet been reported. Herein, we describe the clinical course, ultrasonic images and gastrointestinal endoscopy findings of a 28-year-old-male patient with IgA nephropathy with KIN. The pathologic examination of the renal biopsy specimen demonstrated mild mesangial proliferative IgA nephropathy with KIN. Molecular genetic testing detected an abnormality in FAN1 gene. The heterozygous mutation was present on chromosome 15q13.3. However, IgA nephropathy with KIN is a rare disorder, and its pathogenesis is yet to be clarified.
Collapse
Affiliation(s)
- Ziliang Wang
- Department of Nephrology, Jinan People's Hospital Affiliated to Shandong First Medical University, Jinan, China.
| | - Xiaona Ni
- Department of Nephrology, Jinan People's Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Shuangshuang Zhu
- Department of Renal Pathology, King Medical Diagnostics Center, Guangzhou, China
| | - Shuling Yue
- Department of Renal Pathology, King Medical Diagnostics Center, Guangzhou, China
| |
Collapse
|
4
|
Law S, Gillmore J, Gilbertson JA, Bass P, Salama AD. Karyomegalic interstitial nephritis with a novel FAN1 gene mutation and concurrent ALECT2 amyloidosis. BMC Nephrol 2020; 21:74. [PMID: 32111193 PMCID: PMC7049196 DOI: 10.1186/s12882-020-01733-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 02/19/2020] [Indexed: 11/18/2022] Open
Abstract
Background Karyomegalic interstitial nephritis (KIN) is a rare hereditary cause of chronic kidney disease. It typically causes progressive renal impairment with haemoproteinuria requiring renal replacement therapy before 50 years of age. It has been associated with mutations in the Fanconi anaemia-associated nuclease 1 (FAN1) gene and has an autosomal recessive pattern of inheritance. Leukocyte chemotactic factor 2 amyloidosis (ALECT2) is the third most common cause of amyloid nephropathy presenting with chronic kidney disease and variable proteinuria. We report a novel mutation in the FAN1 gene causing KIN and to our knowledge, the first case of concurrent KIN and ALECT. Case presentation We describe the case of 44 year old Pakistani woman, presenting with stage four non-proteinuric chronic kidney disease, and a brother on dialysis. Renal biopsy demonstrated KIN and concurrent ALECT2. Genetic sequencing identified a novel FAN1 mutation as the cause of her KIN and she is being managed conservatively for chronic kidney disease. Her brother also had KIN with no evidence of amyloidosis and is being worked up for kidney transplantation. Conclusion This case highlights two rare causes of chronic kidney disease considered underdiagnosed in the wider population due to their lack of proteinuria, and may contribute to the cohort of patients reaching end stage renal disease without a renal biopsy. We report a novel mutation of the FAN1 gene causing KIN, and report the first case of concurrent KIN and ALECT2. This case highlights the importance of renal biopsy in chronic kidney disease of unclear aetiology which has resulted in a diagnosis with implications for kidney transplantation and family planning.
Collapse
Affiliation(s)
- Steven Law
- UCL Department of Renal Medicine, Centre for Experimental Nephrology, Royal Free Hospital, NW3 2PF, London, UK.,National Amyloidosis Centre, Division of Medicine, University College London, NW3 2PF, London, UK
| | - Julian Gillmore
- National Amyloidosis Centre, Division of Medicine, University College London, NW3 2PF, London, UK
| | - Janet A Gilbertson
- National Amyloidosis Centre, Division of Medicine, University College London, NW3 2PF, London, UK
| | - Paul Bass
- Department of Pathology, Royal Free Hospital, NW3 2PF, London, UK
| | - Alan D Salama
- UCL Department of Renal Medicine, Centre for Experimental Nephrology, Royal Free Hospital, NW3 2PF, London, UK.
| |
Collapse
|
5
|
Ravindran A, Cortese C, Larsen CP, Wadei HM, Gandhi MJ, Cosio FG, Sethi S. Karyomegalic interstitial nephritis in a renal allograft. Am J Transplant 2019; 19:285-290. [PMID: 30040181 DOI: 10.1111/ajt.15035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 07/11/2018] [Accepted: 07/18/2018] [Indexed: 01/25/2023]
Abstract
Karyomegalic interstitial nephritis (KIN) is a rare renal interstitial disease entity characterized by large tubular nuclei, accompanied by interstitial inflammation, tubular atrophy, and interstitial fibrosis. Approximately 50 cases of KIN have been described in the native kidney. In this case study, we describe the first case of KIN in a kidney allograft. A 41-year-old man presented with declining kidney function and a serum creatinine of 2.7 mg/dL. The native kidney biopsy showed large pleomorphic nuclei in the proximal and distal tubular epithelial cells, which was associated with interstitial inflammation, and extensive interstitial fibrosis and tubular atrophy. Immunohistochemistry for cytomegalovirus, adenovirus, and simian virus 40 were negative. A diagnosis of KIN was rendered. The patient received a living-related kidney transplant from his sister. At 4-, 12-, and 24-months posttransplant, protocol allograft biopsies showed KIN with large pleomorphic nuclei in the proximal and distal tubules with mild interstitial inflammation, minimal tubular atrophy, and interstitial fibrosis. At 24.7 months of follow-up, the patient has stable renal function with a serum creatinine of 1.6 mg/dL. The KIN may represent recurrent KIN or donor-associated KIN. Recognition of this rare disease entity is important as it can be mistaken for a viral infection.
Collapse
Affiliation(s)
- Aishwarya Ravindran
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Cherise Cortese
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Hani M Wadei
- Department of Transplant, Mayo Clinic, Jacksonville, FL, USA
| | - Manish J Gandhi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Fernando G Cosio
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sanjeev Sethi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|