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Bijol V, Mendez GP, Nosé V, Rennke HG. Granulomatous Interstitial Nephritis: A Clinicopathologic Study of 46 Cases from a Single Institution. Int J Surg Pathol 2016; 14:57-63. [PMID: 16501836 DOI: 10.1177/106689690601400110] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Acute interstitial nephritis is commonly seen in kidney biopsies of patients with acute renal failure; however, granulomatous interstitial nephritis (GIN) is rare. We identified 46 cases of GIN in a 17-year period in this institution and we investigated their most probable etiologies. Complete clinical information was available in 38 patients. Seventeen of 38 patients (44.7%) were classified as drug-induced. Renal sarcoidosis was responsible for 28.9% of cases, and the remaining 15.9% of cases included Wegeners granulomatosis, foreign body giant cell reaction, GIN secondary to intravesical bacillus Calmette-Guerin therapy for bladder cancer, and xanthogranulomatous pyelonephritis. Clinical investigation failed to reveal possible etiology in 4 patients (10.5%), classified as idiopathic. We concluded that three quarters of our cases were either drug-induced or due to sarcoidosis; only a small proportion of our cases occurred secondary to any other cause or to unknown factors.
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Affiliation(s)
- Vanesa Bijol
- Department of Pathology, Brigham and Womens Hospital--Harvard Medical School, Boston, MA, USA
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Shah S, Carter-Monroe N, Atta MG. Granulomatous interstitial nephritis. Clin Kidney J 2015; 8:516-23. [PMID: 26413275 PMCID: PMC4581373 DOI: 10.1093/ckj/sfv053] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 06/10/2015] [Indexed: 01/29/2023] Open
Abstract
Granulomatous interstitial nephritis (GIN) is a rare entity detected in ∼0.5-0.9% of all renal biopsies. GIN has been linked to several antibiotics such as cephalosporins, vancomycin, nitrofurantoin and ciprofloxacin. It is also associated with NSAIDs and granulomatous disorders such as sarcoidosis, tuberculosis, fungal infections, and granulomatosis with polyangiitis. Renal biopsy is critical in establishing this diagnosis, and the extent of tubular atrophy and interstitial fibrosis may aid in determining prognosis. Retrospective data and clinical experience suggest that removal of the offending agent in conjunction with corticosteroid therapy often results in improvement in renal function. We describe a patient with a history of multiple spinal surgeries complicated by wound infection who presented with confusion and rash with subsequent development of acute kidney injury. Urinalysis demonstrated pyuria and eosinophiluria, and renal biopsy revealed acute interstitial nephritis with granulomas. These findings were attributed to doxycycline treatment of his wound infection. This review explores the clinical associations, presentation, diagnosis, and treatment of this uncommon cause of acute kidney injury.
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Nadri Q, Althaf MM. Granulomatous tubulointerstitial nephritis secondary to omeprazole. BMJ Case Rep 2014; 2014:bcr-2014-203842. [PMID: 25323274 DOI: 10.1136/bcr-2014-203842] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Drug-induced interstitial nephritis is a common cause of acute kidney injury indicated by elevated serum creatinine. We report a case of omeprazole-induced acute granulomatous interstitial nephritis (GIN). Our patient developed acute GIN secondary to omeprazole ingestion requiring haemodialysis. Treatment with steroids and withdrawal of omperazole was successful allowing the patient to discontinue haemodialysis in 3 months. She remains dialysis free with chronic kidney disease stage IV, reflected by a serum creatine of 191 μmol/L and estimated glomerular filtration rate of 23 mL/min/1.73 m(2) at 5 years on follow-up.
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Affiliation(s)
- Quaid Nadri
- Department of Medicine, Section of Nephrology, King Faisal Specialist Hospital and Research Center, Riyadh, Ar-Riyadh, Saudi Arabia
| | - Mohammed Mahdi Althaf
- Department of Medicine, Section of Nephrology, King Faisal Specialist Hospital and Research Center, Riyadh, Ar-Riyadh, Saudi Arabia
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Pasquet F, Chauffer M, Karkowski L, Debourdeau P, Mc Grégor B, Labeeuw M, Laville M, Pavic M. [Granulomatous interstitial nephritis: A retrospective study of 44 cases]. Rev Med Interne 2010; 31:670-6. [PMID: 20605281 DOI: 10.1016/j.revmed.2010.04.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2009] [Revised: 04/10/2010] [Accepted: 04/25/2010] [Indexed: 11/29/2022]
Abstract
PURPOSE Granulomatous interstitial nephritis (GIN) are identified in 0.5 to 1,3% of all renal biopsies. Renal outcome and treatment modalities are not clearly established in the literature. METHODS We retrospectively analyzed a case series of 44 GIN identified among all renal biopsies performed between 1984 and 2005 in the Rhône-Alpes area. RESULTS The study population included 25 men and 19 women with a mean age of 56 years, and mean diagnostic delay was 11 months. Renal function was severely impaired (mean creatinine clearance 24mL/min). Proteinuria was observed in 77% (mean value 0,9 g/24h) of the patients and associated with microscopic hematuria and leukocyturia in 30% and 25%, respectively. The most common diagnosis was sarcoidosis (25%, n = 11), followed by drug-induced GIN (9%, n = 4), tuberculosis (6,8%, n=3), hemopathy-related paraneoplastic GIN (6,8%, n = 3), HIV infection (n = 1) and chronic renal allograft rejection (n = 1). In other patients, no aetiology was found (48%, n = 21). Severity of renal failure justified hemodialysis in 34% (n = 15) of the patients. Three patients underwent renal transplantation. Nonetheless, renal outcome was generally favorable: renal function improved in 41% (n = 18) and stabilized in 34% (n = 15) of patients. CONCLUSIONS Sarcoidosis, drug-induced and infections represent the main causes of GIN. Histologic features are not specific enough to determine the aetiology. Corticosteroids is the gold standard in sarcoidosis, drug-induced, and idiopathic GIN. Treatment is etiologic in the other cases.
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Affiliation(s)
- F Pasquet
- Service de médecine interne-oncologie, hôpital d'instruction des armées Desgenettes, 69003 Lyon, France.
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Fernández Tagarro EJ, de Gracia Núñez R, Sánchez Villanueva RJ, Riñón Aguilar C, Selgas Gutiérrez R. [Prokinetic agents as a cause of granulomatous interstitial nephritis]. GASTROENTEROLOGIA Y HEPATOLOGIA 2008; 30:583-4. [PMID: 18028853 DOI: 10.1157/13112585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Granulomatous interstitial nephritides are uncommon entities in routine clinical practice. These entities are usually associated with infectious diseases such as tuberculosis, or immune diseases, such as sarcoidosis, systemic lupus erythematosus or cryoglobulinemia. However, these diseases are most frequently associated with drug intake, especially antibiotics, proton pump inhibitors and nonsteroidal anti inflammatory drugs. An association with prokinetic agents has not previously been reported. We report the case of a 64-year-old woman who developed acute renal failure with this histological pattern after taking the motility promoter cinitapride without her physician's knowledge.
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Allergic interstitial nephritis possibly related to sunitinib use. ACTA ACUST UNITED AC 2007; 5:341-4. [DOI: 10.1016/j.amjopharm.2007.12.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2007] [Indexed: 11/20/2022]
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Adams AL, Cook WJ. Granulomatous interstitial nephritis secondary to histoplasmosis. Am J Kidney Dis 2007; 50:681-5. [PMID: 17900469 DOI: 10.1053/j.ajkd.2007.06.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Accepted: 06/21/2007] [Indexed: 11/11/2022]
Affiliation(s)
- Amy L Adams
- Department of Pathology, University of Alabama at Birmingham, AL 35249, USA.
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Javaud N, Belenfant X, Stirnemann J, Laederich J, Ziol M, Callard P, Ronco P, Rondeau E, Fain O. Renal granulomatoses: a retrospective study of 40 cases and review of the literature. Medicine (Baltimore) 2007; 86:170-180. [PMID: 17505256 DOI: 10.1097/md.0b013e3180699f55] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Renal granulomatoses represent 0.5%-0.9% of nephropathies examined by renal biopsies. Granulomas can be isolated to the kidney or associated with other tissue involvement. We describe 40 consecutive patients with renal granulomatoses, associated with pauci-immune crescentic glomerulonephritis in 2 patients and with vasculitis in another, seen in northeastern Paris hospitals between January 1991 and February 2004. The criterion for inclusion was the presence of 1 or more epithelioid granulomas in the renal interstitium. Our population of 25 men and 15 women had a median age of 53 years. All patients suffered from renal insufficiency with median creatininemia of 236.8 micromol/L (range, 124-805 micromol/L), associated with hypertension (25%), median proteinuria of 0.6 g/24 h (range, 0.08-3.00 g/24 h), microscopic hematuria (15%) and leukocyturia (22.5%). Histologic examination of extrarenal specimens detected granulomas in 82.4% of the bronchial biopsies taken, and in 100% of the 2 skin biopsies, the 2 lymph-node biopsies, and the liver and colon biopsies. The following etiologies were retained: sarcoidosis for 20 (50%) patients, drug-induced for 7 (17.5%), tuberculosis for 3 (7.5%), Wegener granulomatosis for 2 (5%), and leprosy, Mycobacterium avium infection, and Crohn disease for 1 (2.5%) patient each. No etiology could be identified for 5 (12.5%) patients. Treatment must be adapted to the etiology of each case. The renal outcome after treatment was generally favorable, with the estimated median creatinine clearance increasing from 26 mL/min (range, 5.4-80.0 mL/min) to 46.5 mL/min (range, 0-118 mL/min) after a median follow-up of 35.5 months (range, 3-158 mo). Nonetheless, 32 patients had persistent renal insufficiency; 1 required hemodialysis and another underwent renal transplantation. Sarcoidosis and medications are the most common causes of renal granulomatosis. Idiopathic and drug-induced forms do not relapse after treatment discontinuation, and remission persists at long-term follow-up.
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Affiliation(s)
- Nicolas Javaud
- From Service de Médecine Interne (NJ, JS, OF) and Service d'Anatomie et de Cytologie Pathologique (MZ), AP-HP, Hôpital Jean-Verdier, Bondy; Université Léonard De Vinci-Paris 13 (MZ, OF), Bobigny; Service de Néphrologie (NJ, XB, JL), Hôpital Intercommunal André-Grégoire, Montreuil; Service d'Anatomie et de Cytologie Pathologique (PC), Service de Néphrologie et Dialyses (PR), and Service d'Urgences Néphrologiques et Transplantation Rénale (ER), AP-HP, Hôpital Tenon, Paris; and Université Pierre et Marie Curie-Paris 6 (PC,ER, PR), Paris, France
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Peña de la Vega L, Fervenza FC, Lager D, Habermann T, Leung N. Acute granulomatous interstitial nephritis secondary to bisphosphonate alendronate sodium. Ren Fail 2005; 27:485-9. [PMID: 16060139 DOI: 10.1081/jdi-65397] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Chronic lymphocytic leukemia (CLL) is the most common leukemia in the Western world and is characterized by a progressive accumulation of functionally incompetent monoclonal lymphocytes. Renal involvement has been described in CLL but is uncommon. Granulomatous interstitial nephritis is a rare but characteristic hallmark of certain diseases such as sarcoidosis and tuberculosis. These epithelial reactions have also been reported with medications, infections, inflammation, Wegener's granulomatosis, and jejunoileal bypass. We present a 74-year-old woman with a stage 0 chronic lymphocytic leukemia who developed acute renal failure following the initiation of alendronate. The renal biopsy revealed an acute granulomatous interstitial nephritis. Infectious and inflammatory etiologies were ruled out. Hemodialysis was required despite discontinuation of all medications. Partial recovery of renal function occurred after 6 weeks of prednisone therapy and cyclophosphamide. This report describes a unique case of acute granulomatous interstitial nephritis and leukemic cell kidney infiltration by CLL.
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MESH Headings
- Acute Disease
- Acute Kidney Injury/chemically induced
- Acute Kidney Injury/drug therapy
- Acute Kidney Injury/pathology
- Aged
- Alendronate/adverse effects
- Alendronate/therapeutic use
- Biopsy, Needle
- Female
- Follow-Up Studies
- Humans
- Immunohistochemistry
- Immunosuppressive Agents/therapeutic use
- Kidney Function Tests
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Nephritis, Interstitial/chemically induced
- Nephritis, Interstitial/drug therapy
- Nephritis, Interstitial/pathology
- Osteoporosis/complications
- Osteoporosis/diagnosis
- Osteoporosis/drug therapy
- Risk Assessment
- Severity of Illness Index
- Treatment Outcome
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Affiliation(s)
- Lourdes Peña de la Vega
- Department of Internal Medicine, Division of Nephrology, Mayo Clinic, Rochester, Minnesota 55905, USA
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Torpey N, Barker T, Ross C. Drug-induced tubulo-interstitial nephritis secondary to proton pump inhibitors: experience from a single UK renal unit. Nephrol Dial Transplant 2004; 19:1441-6. [PMID: 15004262 DOI: 10.1093/ndt/gfh137] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Acute tubulo-interstitial nephritis (TIN) is an important cause of acute renal failure, and is often caused by hypersensitivity to drugs. The aim of this study was to determine the aetiology of interstitial nephritis among an unselected cohort of patients, and to identify those drugs commonly implicated. METHODS A single-centre retrospective analysis was carried out of renal biopsy results from 296 consecutive patients between 1995 and 1999. RESULTS Acute TIN was identified in 24 (8.1%) biopsies. Eight out of 14 cases with presumed drug-related TIN could be attributed to the proton pump inhibitors omeprazole and lansoprazole. The two cases of lansoprazole-associated TIN are the first to be reported with this drug. The presentation and favourable response to treatment of these patients are described. CONCLUSION Drugs are the most common cause of interstitial nephritis in the population studied. Those drugs most commonly associated with interstitial nephritis were the proton pump inhibitors omeprazole and lansoprazole.
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Affiliation(s)
- Nicholas Torpey
- Renal Unit, Norfolk and Norwich University Hospital, Norwich, UK.
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Singh AK, Colvin RB. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 36-2003. A 68-year-old woman with impaired renal function. N Engl J Med 2003; 349:2055-63. [PMID: 14627791 DOI: 10.1056/nejmcpc030028] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Ajay K Singh
- Renal Division, Department of Medicine, Brigham and Women's Hospital, USA
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Fervenza FC, Kanakiriya S, Kunau RT, Gibney R, Lager DJ. Acute granulomatous interstitial nephritis and colitis in anticonvulsant hypersensitivity syndrome associated with lamotrigine treatment. Am J Kidney Dis 2000; 36:1034-40. [PMID: 11054362 DOI: 10.1053/ajkd.2000.19107] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We present the case of a 17-year-old woman with a history of bipolar disorder, who developed a clinical syndrome manifested by fever, lymphadenopathy, skin rash, diarrhea, and acute renal failure requiring dialysis after the use of lamotrigine. Renal biopsy showed acute interstitial nephritis (AIN) with focal granulomas. Similarly, colonic biopsy specimens showed colitis and ileitis with non-necrotizing epithelioid granulomas. The patient had a complete recovery after withdrawal of the medication and steroid treatment. Although lamotrigine has been previously implicated in the development of anticonvulsant hypersensitivity syndrome, there have been no previous reports of acute granulomatous interstitial nephritis or colitis associated with the use of this drug.
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Affiliation(s)
- F C Fervenza
- Division of Nephrology, Baylor University Medical Center, Dallas, TX, USA.
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