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Nassih H, El Qadiry R, Bourrahouat A, Ait Sab I. Challenges in the Diagnosis and Management of Nephrotic Syndrome in a Child With Multisystemic Tuberculosis. Glob Pediatr Health 2022; 9:2333794X221078703. [PMID: 35237712 PMCID: PMC8882937 DOI: 10.1177/2333794x221078703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/20/2022] [Indexed: 11/25/2022] Open
Abstract
We report the case of a child who had tuberculosis associated with nephrotic syndrome. In
this case, it was difficult to identify if the renal involvement was due to renal
infection with mycobacterium tuberculosis, the consequence of nephrotoxicity of
anti-bacillary drugs, or due to new onset of nephrosis. Management was complex as the use
of high-dose steroids can disseminate the infection.
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2
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So PNH, Villanueva ART. Serologic and urinary characteristics of laboratory-confirmed genitourinary tuberculosis at a tertiary hospital in the Philippines. BMC Urol 2021; 21:125. [PMID: 34503465 PMCID: PMC8431859 DOI: 10.1186/s12894-021-00888-3] [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] [Received: 02/18/2021] [Accepted: 08/23/2021] [Indexed: 12/04/2022] Open
Abstract
Background Genitourinary tuberculosis (GUTB) is known to cause high rates of structural organ damage, however, literature on its biochemical manifestations is limited. Additionally, local studies in the Philippine setting, where cases are rampant, are few and dated. This study aimed to determine the serologic and urinary profile of patients with GUTB admitted at a tertiary hospital within January 2009 to March 2020 and their association with short-term outcomes. Methods This retrospective study included 112 patients with laboratory-confirmed GUTB (i.e., positivity in acid-fast smear, polymerase chain reaction, culture, or histology). Demographic data, clinical characteristics, laboratory and radiologic findings, histopathology reports, treatment, and short-term outcomes were recorded. Results Bladder (54.5%) and kidney (36.4%) were the most affected organs. The male:female ratio was 1:1.15, and the mean age was 35.79 ± 18.29 years. Weakness (14.29%) was the most common chief complaint. A majority presented with anemia (83.04%), while several had leukocytosis (41.96%) and thrombocytosis (26.79%). Hypoalbuminemia (58.10%), impairment of renal function (36.94%), and electrolyte abnormalities such as hyponatremia (50.93%), hypercalcemia (20.19%), and hypokalemia (21.82%) were common. Proteinuria (67.96%) and pyuria (67.96%) were the most frequent abnormal findings, followed by hematuria (51.46%), acidic urine (45.63%) and low specific gravity (31.07%). Age, leukocytosis, and the need for pressors were all significantly associated with mortality (p values of <0.001, 0.010, and <0.001, respectively). Conclusions The young age at presentation with severe clinical and laboratory manifestations may reflect local epidemiology as TB continues to be widespread in the country. Apart from the more commonly cited abnormalities in literature, multiple electrolyte imbalances and urinary concentration defects were also observed in many cases, possibly indicating tubulointerstitial involvement—a complication increasingly mentioned in case reports. As several patient characteristics were found to be associated with the high mortality rates observed in the study, further research is recommended to explore predictive modeling.
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Affiliation(s)
- Paolo Nikolai H So
- Division of Nephrology, Department of Medicine, University of the Philippines Manila - Philippine General Hospital, Taft Avenue, Ermita, 1000, Manila, Philippines.
| | - Anthony Russell T Villanueva
- Division of Nephrology, Department of Medicine, University of the Philippines Manila - Philippine General Hospital, Taft Avenue, Ermita, 1000, Manila, Philippines
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Janssen U, Naderi S, Amann K. Idiopathic granulomatous interstitial nephritis and isolated renal sarcoidosis: Two diagnoses of exclusion. SAGE Open Med 2021; 9:20503121211038470. [PMID: 34408878 PMCID: PMC8366196 DOI: 10.1177/20503121211038470] [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: 03/12/2021] [Accepted: 07/22/2021] [Indexed: 02/04/2023] Open
Abstract
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.
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Affiliation(s)
- Ulf Janssen
- Department of Nephrology and Diabetology, Kliniken Maria Hilf, Mönchengladbach, Germany
| | | | - Kerstin Amann
- Department of Nephropathology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
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Furuto Y, Hashimoto H, Kawamura M, Yamashita J, Yoshikawa T, Namikawa A, Isshiki R, Takahashi H, Morikawa T, Shibuya Y. Acute tubulointerstitial nephritis in a patient with early bronchial tuberculosis. J Formos Med Assoc 2021; 121:557-562. [PMID: 34301423 DOI: 10.1016/j.jfma.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/04/2021] [Accepted: 07/05/2021] [Indexed: 11/19/2022] Open
Abstract
Patients with chronic kidney disease (CKD) are commonly at high risk of tuberculosis (TB). Conversely, TB rarely causes tubulointerstitial nephritis. A 75-year-old Japanese man who was undergoing periodic follow-ups for CKD stage G3aA3 with membranous nephropathy was diagnosed with acute kidney injury (AKI) (estimated glomerular filtration rate [eGFR]: 15 mL/min/1.73 m2) without prerenal AKI. He reported developing recent-onset cough 3 weeks prior to presenting to us. Renal biopsy revealed acute tubulointerstitial nephritis along with known membranous nephropathy. CD4+ helper T cells comprised most lymphocytes in the tubulointerstitium. Results of the interferon-gamma release assay, sputum smear test, polymerase chain reaction (PCR), and culture test were positive for TB. Chest computed tomography revealed thickening of the left bronchial wall; therefore, a diagnosis of early bronchial TB was made; his urine culture and PCR were negative for TB. At four months after TB treatment with no immunosuppressive therapy, his eGFR improved to 50 mL/min/1.73 m2, and based on this progress, the AKI was diagnosed as tuberculosis-associated tubulointerstitial nephritis (TATIN). Although TATIN typically occurs with chronic or miliary tuberculosis, it is very rare in early bronchial TB. Identification of TATIN is important in kidney diseases of unknown etiology, and treatment with anti-TB drugs is necessary.
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Affiliation(s)
- Yoshitaka Furuto
- Department of Hypertension and Nephrology, NTT Medical Centre Tokyo, 5-9-22, Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8625, Japan.
| | - Hirotsugu Hashimoto
- Department of Diagnostic Pathology, NTT Medical Centre Tokyo, 5-9-22, Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8625, Japan
| | - Mariko Kawamura
- Department of Hypertension and Nephrology, NTT Medical Centre Tokyo, 5-9-22, Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8625, Japan
| | - Jumpei Yamashita
- Department of Hypertension and Nephrology, NTT Medical Centre Tokyo, 5-9-22, Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8625, Japan
| | - Takahiro Yoshikawa
- Department of Hypertension and Nephrology, NTT Medical Centre Tokyo, 5-9-22, Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8625, Japan
| | - Akio Namikawa
- Department of Hypertension and Nephrology, NTT Medical Centre Tokyo, 5-9-22, Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8625, Japan
| | - Rei Isshiki
- Department of Hypertension and Nephrology, NTT Medical Centre Tokyo, 5-9-22, Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8625, Japan
| | - Hiroko Takahashi
- Department of Hypertension and Nephrology, NTT Medical Centre Tokyo, 5-9-22, Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8625, Japan
| | - Teppei Morikawa
- Department of Diagnostic Pathology, NTT Medical Centre Tokyo, 5-9-22, Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8625, Japan
| | - Yuko Shibuya
- Department of Hypertension and Nephrology, NTT Medical Centre Tokyo, 5-9-22, Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8625, Japan
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Gnemmi V, Gibier JB, Humez S, Copin MC, Glowacki F. [Renal granulomatous nephritis: Histopathological point of view]. Ann Pathol 2020; 41:166-175. [PMID: 33277052 DOI: 10.1016/j.annpat.2020.11.001] [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: 12/24/2019] [Revised: 07/22/2020] [Accepted: 11/03/2020] [Indexed: 11/29/2022]
Abstract
Granulomatous interstitial nephritis (NIG) is a rare form of interstitial nephritis that can be related to acute or chronic clinical presentation. NIG is characterized by granulomas located to the renal interstitium and composed of either epithelioid histiocytes with giant cells and/or of foreign body reaction. The symptoms are unspecific and associate varying degrees of renal failure with abnormal urinanalysis. Extra-renal signs may point to systemic disease. Pathological examination from kidney percutaneous biopsy or surgical resection is required to assert NIG diagnosis and to guide the etiological research. The main causes of NIG are sarcoidosis, drug reactions, mycobacterial infections and crystalline nephropathies. Sarcoidosis is characterized by non-necrotic and well-formed giant cell epithelioid interstitial granulomas. Drug reactions have less well-defined granulomas with inconstant eosinophils. The presence of caseous necrosis within giant cell and epithelioid granulomas leads to infectious NIG diagnosis (tuberculosis and fungal infection). Identification of crystals within foreign body reaction can be improved by polarized light study. Xanthogranulomatous pyelonephritis and malakoplakia are rarer causes of NIG characterized by patches of histiocytes associated with inconstant giant cells. Differential diagnoses of NIG are represented by granulomatous reactions centered on glomeruli and vessels (vasculitis and emboli of cholesterol crystals). Less than 10% of NIG are idiopathic. The prognosis and the treatment vary according to the cause. The factors of poor renal prognosis are chronic irreversible tubulo-interstitial injury (tubular atrophy and interstitial fibrosis).
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Affiliation(s)
- Viviane Gnemmi
- UMR9020 - UMR-S 1277, Inserm, CNRS, pathology department, cancer heterogeneity, plasticity and resistance to therapies, Canther, CHU de Lille, université Lille, 59000 Lille, France.
| | - Jean-Baptiste Gibier
- UMR9020 - UMR-S 1277, Inserm, CNRS, pathology department, cancer heterogeneity, plasticity and resistance to therapies, Canther, CHU de Lille, université Lille, 59000 Lille, France
| | - Sarah Humez
- UMR9020 - UMR-S 1277, Inserm, CNRS, pathology department, cancer heterogeneity, plasticity and resistance to therapies, Canther, CHU de Lille, Institut Pasteur de Lille, université Lille, 59000 Lille, France
| | - Marie-Christine Copin
- UMR9020 - UMR-S 1277, Inserm, CNRS, pathology department, cancer heterogeneity, plasticity and resistance to therapies, Canther, CHU de Lille, Institut Pasteur de Lille, université Lille, 59000 Lille, France
| | - François Glowacki
- UMR9020 - UMR-S 1277, Inserm, CNRS, nephrology department, cancer heterogeneity, plasticity and resistance to therapies, Canther, CHU de Lille, université Lille, 59000 Lille, France
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Fernández-Vidal M, Canllavi Fiel E, Bada Bosch T, Trujillo Cuéllar H, García Martín F, Gutiérrez Martínez E, Molina Gómez M, Alonso Riaño M, Praga Terente M. Nefritis intersticial tuberculosa, un diagnóstico difícil que precisa de una alta sospecha. Nefrologia 2020; 40:475-477. [DOI: 10.1016/j.nefro.2019.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/15/2019] [Accepted: 05/25/2019] [Indexed: 12/01/2022] Open
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Delafosse M, Teuma C, Miailhes P, Nouvier M, Rabeyrin M, Fouque D. Severe tubulointerstitial nephritis: tracking tuberculosis even in the absence of renal granuloma. Clin Kidney J 2018; 11:667-669. [PMID: 30288262 PMCID: PMC6165755 DOI: 10.1093/ckj/sfx157] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 12/01/2017] [Indexed: 11/12/2022] Open
Abstract
Extra-pulmonary tuberculosis is frequently located in the kidneys and, in such cases, could be associated with a granulomatous interstitial nephritis. Granulomas are not always detected, especially in human immunodeficiency virus (HIV)-positive patients. We report here a case of tubulointerstitial nephritis without granulomas in an HIV-negative patient. Since all laboratory tests failed to isolate Mycobacterium tuberculosis in the kidney, a targeted biopsy guided by positron emission tomography-computed tomography was performed on a mediastinal node, revealing a positive culture. After 6 months of treatment, no recovery of the renal injury has been observed.
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Affiliation(s)
- Marion Delafosse
- Department of Nephrology, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Université de Lyon, Lyon, France
| | - Cécile Teuma
- Department of Nephrology, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Université de Lyon, Lyon, France
| | - Patrick Miailhes
- Department of Infectious Diseases, Hôpital Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Mathilde Nouvier
- Department of Nephrology, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Université de Lyon, Lyon, France
| | - Maud Rabeyrin
- Department of Pathology, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - Denis Fouque
- Department of Nephrology, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Université de Lyon, Lyon, France
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Oliveira B, Jayawardene S, Shah S. Single-centre experience of granulomatous interstitial nephritis-time for a new approach? Clin Kidney J 2017; 10:249-254. [PMID: 28396742 PMCID: PMC5381231 DOI: 10.1093/ckj/sfw119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 09/22/2016] [Accepted: 10/10/2016] [Indexed: 11/13/2022] Open
Abstract
Background: Differentiating between renal-limited sarcoidosis and tuberculosis (TB) infection as a cause of granulomatous interstitial nephritis (GIN) can be difficult. This series compares clinical features and response to treatment between the different underlying aetiologies in order to propose a management algorithm for GIN to assist with diagnosis and treatment. Methods: This retrospective study reports on all patients presenting with a histological diagnosis of GIN between 2000 and 2012 at our unit. Results: Twenty-one patients were identified, 57% were male and the mean age was 53 years. Eight cases were associated with sarcoidosis with evidence of extra-renal disease and five with renal-limited sarcoidosis. Five patients had GIN that may have been related to TB infection or to renal-limited sarcoidosis, and three were idiopathic or drug related. All those with sarcoidosis were treated with steroids and renal function, as measured by estimated glomerular filtration rate (eGFR), improved from a mean of 24 mL/min at baseline to 37 mL/min at 1 year. Baseline eGFR was 19 mL/min in those with possible TB infection. Four received steroids as well as anti-TB drugs. Anti-TB therapy was delayed in four patients by a mean of 22 months due to difficulties in diagnosis. Two patients with TB developed end-stage kidney disease and the remaining three patients had a mean eGFR of 28 mL/min at 1 year. Conclusions: This series represents the largest cohort of patients with GIN in the UK and supports previous findings that patients with sarcoid have a favourable outcome with steroid treatment. Those with TB have an inferior prognosis, perhaps due to delayed diagnosis. We suggest an algorithm when investigating a diagnosis of GIN with the aim of expediting diagnosis and considering a trial of anti-TB therapy in order to prevent deterioration of renal function.
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Affiliation(s)
| | | | - Sapna Shah
- Renal Unit, King's College Hospital, London, UK
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Prendecki M, Tanna A, Salama AD, Tam FWK, Cairns T, Taube D, Cook HT, Ashby D, Duncan ND, Pusey CD. Long-term outcome in biopsy-proven acute interstitial nephritis treated with steroids. Clin Kidney J 2016; 10:233-239. [PMID: 28396740 PMCID: PMC5381232 DOI: 10.1093/ckj/sfw116] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/03/2016] [Indexed: 12/24/2022] Open
Abstract
Background: There are no prospective randomized controlled trials describing the outcome of acute interstitial nephritis (AIN) treated with steroids, and retrospective studies are limited. Methods: We identified adult patients with a diagnosis of AIN without glomerular pathology over a 14-year period. Treated patients all received oral prednisolone and three also recieved IV methylprednisolone. Data were collected retrospectively on estimated glomerular filtration rate (eGFR), change in eGFR from time of biopsy, dependence on renal replacement therapy (RRT) and mortality, and outcomes were analysed according to the treatment prescribed. Results: A total of 187 eligible patients with AIN were identified and 158 were treated with steroids. There was no difference in median eGFR or dependence on RRT at the time of biopsy. Steroid-treated patients had significantly higher eGFR at all time points post-biopsy up to 24 months, when median eGFR was 43 mL/min in the steroid-treated group and 24 mL/min in the untreated group (P = 0.01). Fewer patients in the steroid-treated group were dialysis dependent by 6 months (3.2% versus 20.6%, P = 0.0022) and 24 months (5.1% versus 24.1%, P = 0.0019). Conclusions: This large retrospective study suggests a benefit of steroids in treatment of AIN with greater improvement in eGFR and fewer patients progressing to end-stage renal disease.
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Affiliation(s)
- Maria Prendecki
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK
| | - Anisha Tanna
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK
| | - Alan D Salama
- UCL Centre for Nephrology, Royal Free Hospital, London, UK
| | - Frederick W K Tam
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK
| | - Tom Cairns
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK
| | - David Taube
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK
| | - H Terence Cook
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK
| | - Damien Ashby
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK
| | - Neil D Duncan
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK
| | - Charles D Pusey
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK
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Aleckovic-Halilovic M, Nel D, Woywodt A. Granulomatous interstitial nephritis: a chameleon in a globalized world. Clin Kidney J 2015; 8:511-5. [PMID: 26413274 PMCID: PMC4581397 DOI: 10.1093/ckj/sfv092] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 08/31/2015] [Indexed: 02/05/2023] Open
Affiliation(s)
- Mirna Aleckovic-Halilovic
- Department of Nephrology, Dialysis and Transplantation , University Clinical Hospital Tuzla , Tuzla , Bosnia and Herzegovina
| | - Debbie Nel
- University of Cape Town , Cape Town , South Africa
| | - Alexander Woywodt
- Department of Renal Medicine , Lancashire Teaching Hospitals NHS Foundation Trust , Preston, Lancashire , UK
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Affiliation(s)
- B Oliveira
- From the Kent Kidney Care Centre, Kent & Canterbury Hospital, Ethelbert Road, Canterbury, Kent, CT1 3NG, UK
| | - T Ali
- From the Kent Kidney Care Centre, Kent & Canterbury Hospital, Ethelbert Road, Canterbury, Kent, CT1 3NG, UK
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Praga M, Sevillano A, Auñón P, González E. Changes in the aetiology, clinical presentation and management of acute interstitial nephritis, an increasingly common cause of acute kidney injury. Nephrol Dial Transplant 2014; 30:1472-9. [PMID: 25324356 DOI: 10.1093/ndt/gfu326] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 09/15/2014] [Indexed: 01/10/2023] Open
Abstract
Acute interstitial nephritis (AIN) is an important cause of acute kidney injury that has experienced significant epidemiological and clinical changes in the last years. The classical presentation, mostly induced by antibiotics and accompanied by evident hypersensitivity manifestations (skin rash, eosinophilia, fever) has been largely replaced by oligosymptomatic presentations that require a higher index of suspicion and are increasingly recognized in the elderly, having non-steroidal anti-inflammatory agents and proton pump inhibitors as frequent offending drugs. Drug-induced AIN continues to be the commonest type, but it requires a careful differential diagnosis with other entities (tubulointerstitial nephritis with uveitis syndrome, IgG4-related disease, drug reaction with eosinophilia and systemic symptom syndrome, sarcoidosis and other systemic diseases) that can also induce AIN. Cortico-dependant, relapsing AIN is a recently recognized entity that poses an important therapeutic challenge. Although corticosteroids are widely used in drug-induced AIN to speed kidney function recovery and avoid chronic kidney disease, their efficacy has not been tested by randomized controlled trials. New diagnostic tests and biomarkers, as well as prospective therapeutic studies are needed to improve AIN diagnosis and management.
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Affiliation(s)
- Manuel Praga
- Division of Nephrology, Hospital 12 de Octubre*, Madrid, Spain Department of Medicine, Complutense University, Madrid, Spain
| | - Angel Sevillano
- Division of Nephrology, Hospital 12 de Octubre*, Madrid, Spain
| | - Pilar Auñón
- Division of Nephrology, Hospital 12 de Octubre*, Madrid, Spain
| | - Ester González
- Division of Nephrology, Hospital 12 de Octubre*, Madrid, Spain
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