Severe reversible renal failure due to naproxen-associated acute interstitial nephritis

Acute interstitial nephritis is uncommon in children and has very rarely been described with naproxen treatment. We report the occurrence of severe acute renal failure in a 10-year-old girl with juvenile rheumatoid arthritis after 1 month of naproxen therapy. Renal biopsy showed severe acute interstitial nephritis. The patient recovered completely after discontinuation of naproxen and administration of methylprednisolone. A review of the literature regarding non-steroidal anti-inflammatory drug-associated acute interstitial nephritis is provided. CONCLUSION: In an era of increasing popularity of non-steroidal anti-inflammatory drugs for use in children, paediatricians should be aware of the potential renal complications of this class of drugs.     

Recurrent acute interstitial nephritis induced by azithromycin

A 14-year-old girl is reported with recurrent, azithromycin-induced, acute interstitial nephritis. The second episode was more severe than the first; and although both were treated with intensive corticosteroid therapy, renal function remained impaired. Although most cases of antibiotic induced acute interstitial nephritis are benign and self-limited, some patients are at risk for permanent renal injury.     

Naproxen nephrotoxicity in a 2-year-old child

The development of acute renal failure and interstitial nephritis due to therapeutic doses of nonsteroidal anti-inflammatory drugs has been documented repeatedly in adult patients but is rare in children. We report the occurrence of this complication in a child. Acute renal failure and hyperkalemia developed in a 2-year-old boy with juvenile rheumatoid arthritis after one month of naproxen sodium therapy. The evidence of renal toxic effects became manifest after an episode of dehydration. A percutaneous renal biopsy specimen revealed interstitial nephritis. The patient recovered promptly after withdrawal of the drug.     

The role of mast cells in acute tubulo-interstitial nephritis with uveitis

We describe the clinicopathological characteristics of two patients with acute tubulo-interstitial nephritis with uveitis (TINU) with mast cells infiltrating the interstitium. The pathogenesis of TINU remains unknown, but a T-cell-mediated immune response was suggested to be involved. Recent studies have shown that infiltrating mast cells are closely associated with the development of renal interstitial fibrosis in glomerulonephritis. To address the role of mast cells in the renal interstitial injury in TINU, immunohistochemical studies were performed in renal biopsy sections using anti-human mast cell tryptase antibody specific for mast cells. In addition, we tried to detect CD68-positive macrophages to compare with the localisation of mast cells within the renal interstitium. Mast cells and macrophages could be detected in renal interstitial lesions of both patients. Massive infiltration of macrophages into interstitial lesions was observed, whereas mast cells were detected in a sporadic rather than a clustered manner, and associated with fibrotic lesions. Repeat renal biopsy findings suggested the involvement of these cells in the renal interstitial injury because the number of infiltrating mast cells and macrophages in the interstitium decreased with the improvements in clinical symptoms and pathological lesions. CONCLUSION: The present study showed that mast cells might play an important role in the development of renal interstitial injury in tubulo-interstitial nephritis with uveitis.     

Fatal mumps nephritis and myocarditis

The case of a 14-year-old girl with fatal interstitial nephritis and myocarditis as complications of mumps is reported. The illness began with parotitis; renal symptoms developed within a week. The patient's renal and cardiac status and clinical course rapidly deteriorated and the outcome was fatal. The post-mortem renal biopsy sample showed interstitial mononuclear cell infiltration, oedema, and focal tubular epithelial damage in biopsy material of kidney, confirming the clinical diagnosis. Myocarditis was determined by electrocardiographic and echocardiographic findings. Since it has been reported that fatal complications such as myocarditis, dilated cardiomyopathy, and nephritis may develop in the course of mumps, the patients with mumps, especially in complicated cases, should be followed closely because of the severe clinical conditions which may progress.     

Crohn's enteritis and chronic tubulo-interstitial nephropathy in an adolescent

We report for the first time a case of Crohn's enteritis associated with a chronic tubulo-interstitial nephritis in an adolescent. The illness started insidiously in an 11 year-old boy who had suffered from failure to thrive and protracted watery diarrhea. At presentation the patient had an inflammatory bowel disease located to the left colon but no renal dysfunction. Until the age of 15, the intestinal symptoms were stable but a progressive renal insufficiency developed. A percutaneous renal biopsy was then performed which showed a widespread chronic tubulo-interstitial nephritis. Following a 6 months corticosteroid treatment, renal dysfunction seemed to be stabilized. However, delayed growth and corticosteroid dependency led to total colectomy. Pathologic examination showed granulomatosis involvement of the entire colon and severe interstitial nephritis with neither linear nor granulous deposits along tubular basement membranes. After a 2 year-delay following the colectomy, renal function was stabilized and a catch up growth was achieved.     

Terminal renal failure caused by interstitial nephritis following mushroom poisoning by Cortinarius speciocissimus

A 14 year old boy was admitted for vomiting, anorexia, flank pain and leukocyturia/hematuria. Shortly after admission, he developed anuria and acute renal failure so that hemodialysis had to be started. Pre- and post-renal causes were excluded. There were no signs of acute glomerulonephritis; liver enzymes were normal. The 123Iodine-Hippuran scan showed a shock kidney pattern lacking tubular clearance. Renal biopsy revealed an interstitial nephritis with edema and a mixed cellular infiltration. History was empty for nephrotoxic agents except for mushroom ingestion: Five days before admission the boy ate Cortinarius speciocissimus mushrooms, the toxine of which is known to be nephrotoxic, causing irreversible renal failure in severe cases (Orellanus Syndrome). Renal function did not improve much and renal transplantation was performed after 14 months on hemodialysis. In interstitial nephritis of unknown etiology the possibility of mushroom poisoning should be considered.     

Pediatric case of mesalazine‐induced interstitial nephritis with literature review

We present the case of a 14‐year‐old boy with ulcerative colitis who was diagnosed with mesalazine‐induced interstitial nephritis (M‐IIN). Improvement in renal function occurred with discontinuation of mesalazine and corticosteroid therapy. We systematically searched the literature for pediatric cases of M‐IIN. There were eight cases. Majority of the cases were boys (75%) with ulcerative colitis (75%). Average duration of mesalazine use prior to the diagnosis of interstitial nephritis was 24 ± 18 months. The median dose was 1.5 g/day. M‐IIN appears to be an idiosyncratic reaction without any relation to dose or duration of mesalazine use. Although there are no guidelines to recommend routine surveillance of renal function, monitoring of serum creatinine in patients on mesalazine remains an inexpensive and non‐invasive test that may lead to early detection and treatment of renal injury.     

Chronic inflammatory intestinal disease and nephritis]

An 11 year old CD-patient developed an interstitial nephritis and acute kidney failure following treatment with Mesalazine (5-ASA) and Salazosulfapyridine (SASP). After removal of the medication and treatment with hemofiltration and prednisone there was only an incomplete recovery of the renal function (creatinine-clearance 34 ml/1,73 m2/min). It is thought that an hyperergic-allergic reaction due to SASP and 5-ASA causes interstitial nephritis in inflammatory bowel disease (IBD). This reaction can be induced by re-exposition too. On the other hand IBD can be associated with glomerulonephritis. This could be a not very well known extraintestinal manifestation in IBD caused by immune-complexes in serum and glomerula. A rapid histological verification of the renal disease is necessary for successful treatment. In both renal manifestations chronic courses are possible. These observations should not lead to avoid SASP/5-ASA in treatment of IBD, but renal function should be routinely investigated.     

Interstitial nephritis in autoimmune hemolytic anemia

A case is reported of a 15-year-old boy with chronic autoimmune hemolytic anemia who developed renal insufficiency 3 years after splenectomy. An interstitial nephritis with striking lymphocytic infiltrates and sclerosed glomeruli could be demonstrated by percutaneous renal biopsy. Renal symptoms disappeared promptly after corticosteroid therapy. The renal lesions are thought to have arisen as part of the autoimmune disease.     

Acute renal failure due to acute tubulointerstitial nephritis

Acute interstitial nephritis (AIN) should be ruled out in children with unexplained acute renal failure. We present a 4 1/2 year old girl who presented with oliguric acute renal failure preceded by a febrile illness. Renal histopathology revealed features of drug induced AIN. She recovered with dialysis, other supportive treatment and a course of steroids.     

Acute kidney injury in a girl with ulcerative colitis and cytomegalovirus-induced focal segmental glomerular sclerosis

Background

Mesalamine or 5-aminosalicylic acid (5-ASA) has proven efficacy in treating patients with ulcerative colitis (UC). Although mesalamine is considered safe, it has been associated with acute interstitial nephritis and renal failure.

Methods

Herein we present a case of a child with UC who developed acute renal failure on mesalamine therapy.

Results

A 15-year-old African-American girl with well-controlled UC presented to the Johns Hopkins Hospital with a four-day history of high fever, malaise, generalized body aches, and productive non-bloody cough. Over the next three days, she developed acute renal failure with fluid retention, and elevated serum creatinine and blood urea nitrogen. A kidney biopsy showed drug induced acute interstitial nephritis and focal segmental glomerulosclerosis with viral inclusion bodies likely secondary to cytomegalovirus.

Conclusion

When treating UC patients with a history of underlying renal disease, it is advised to carefully monitor renal function while on mesalamine therapy.     

Immunoallergic tubulo-interstitial nephritis following ingestion of carbamazepine

One month after taking carbamazepine for pain relief, a 13 year-old child with Friedrich's ataxia presented with an allergic rash and digestive and cardiac symptoms. Two weeks later, non-oliguric renal failure suggestive of interstitial nephritis was present. Acute renal failure resolved with pulse methyl prednisolone injections relayed with prednisone orally, for 2 months. Allergic manifestations with carbamazepine should lead to immediate withdrawal of treatment.     

Nephrotic syndrome associated with nonsteroidal anti-inflammatory drug use in two children

Two children with nephrotic syndrome in association with nonsteroidal anti-inflammatory drug (NSAID) use are described, and the literature concerning this association is reviewed. NSAIDs are drugs with the potential for causing significant renal toxicity including the nephrotic syndrome, interstitial nephritis, and renal failure even in children without obvious preceding renal disease. Children prescribed such drugs should be regularly monitored with urinalyses and plasma creatinine estimations. The possibility of toxicity to over-the-counter use of NSAIDs should be remembered.     

紫癜性肾炎患儿肾间质血管损害与临床的关系

目的探讨紫癜性肾炎患儿肾间质血管损害与肾脏病理及临床的关系。方法对肾穿刺活检确诊的39例紫癜性肾炎患儿进行肾间质血管损害、肾脏病理积分,并探讨其与临床的关系。结果1.肾脏病理检查中有不同程度肾间质血管损害者36例,占92.3%。其中轻度血管损害15例(38.4%);中度血管损害18例(46.2%);重度血管损害3例(7.7%)。2.肾间质血管中度与轻度损害组相比其血清清蛋白水平明显下降。3.肾间质血管病变积分与肾小球病变、肾间质纤维化、肾小管间质病变、肾脏总的病理损害积分均呈正相关。结论肾间质血管损害在绝大多数紫癜性肾炎患儿中存在,且与肾小球、肾小管间质病变呈正相关关系。     

小儿狼疮性肾炎88例临床分析

目的探讨小儿狼疮性肾炎（ＬＮ）的临床特点。方法对８８例小儿ＬＮ和２００例成人ＬＮ进行了比较分析。结果小儿组男性比例较高，初发症状以发热、消瘦、乏力、水肿、肺部感染等多见；肾脏受累率两组差异不大，但儿童组受累的严重程度较成人重，且从发病至出现肾脏损害的平均时间较短；小儿贫血、血小板减少较多见，狼疮细胞阳性率高；感染为小儿ＬＮ死亡的主要原因。结论小儿ＬＮ的早期诊治很重要     

Sarkoidose

We report the case of a 13-year-old boy who presented with impaired exercise tolerance, loss of weight and fever. Laboratory data indicated systemic inflammation and renal failure suggestive of tubular dysfunction. A kidney biopsy showed epithelioid granulomatous tubulointerstitial nephritis. The boy developed granulomatous uveitis during follow-up. TINU syndrome (tubulointerstitial nephritis and uveitis) was diagnosed and sarcoidosis was considered to be the most probable cause. Treatment was started with prednisone and methotrexate and renal function completely recovered, whereas after 2 years of treatment the uveitis is still mildly active. Sarcoidosis is a rare disease of childhood; nevertheless it must be considered in the differential diagnosis of granulomatous uveitis and tubulointerstitial nephritis.     

肥大细胞在过敏性紫癜肾炎患儿肾间质纤维化中的作用

目的：探讨肥大细胞（mast cell,MC）在过敏性紫癜肾炎（HSPN）患儿肾间质纤维化的作用及可能机制。方法：以20例HSPN患儿肾活检石蜡切片组织作为研究对象,5例肾肿瘤病人行肾切除的远离肿瘤部位的肾石蜡切片组织作为对照组,应用免疫组化方法对肾组织中的β-类胰蛋白酶（肥大细胞活化的标志物）和转化生长因子-β1（transforming growth factor-β1 , TGF-β1）进行检测,用甲苯胺蓝组织化学法计数组织切片中的MC,并与HSPN患儿肾组织病理积分进行相关分析。结果：①肾组织中MC、β-类胰蛋白酶阳性细胞率、TGF-β1的表达水平积分与对照组之间比较差异有显著性（P<0.05）;②肾组织中MC、β-类胰蛋白酶阳性细胞率及TGF-β1的表达水平积分与肾小球病理积分之间有明显的正相关关系（r =0.940,0.920,0.937,P <0.05）、与肾小管间质病理积分之间有明显的正相关关系（r=0.903,0.859,0.948,P <0.05）、与肾间质纤维化积分存在明显正相关关系（r =0.790,0.766,0.858,P<0.05）;③MC与β-类胰蛋白酶阳性细胞率、MC与TGF-β1表达水平积分、β-类胰蛋白酶阳性细胞率与TGF-β1表达水平积分三者之间存在明显的正相关关系（r＝0.941,0.942,0.897,P<0.05）。结论 MC肾组织浸润与小儿HSPN肾间质纤维化的发生发展密切相关,其可能机制为MC及其分泌的β-类胰蛋白酶、TGF-β1共同参与小儿HSPN肾间质纤维化的发生、发展。［中国当代儿科杂志,2007,9（2）：125-128］     

Structure of interstitial nephritis in children]

The authors provide the data on 24 cases of interstitial nephritis in children treated at the Nephrological Center of the city of Kuibyshev in 1986-1990. Describe the etiological structure of interstitial nephritis using the classification developed by N. A. Korovina and coworkers (1982), randomization according to the age, sex, and the disease course. Demonstrate the predominance of the postviral and toxicoallergic disease patterns in children of the early, preschool and junior school age. Estimate the importance of the types of urine proteinograms in the diagnosis of interstitial nephritis.     

Acute tubulointerstitial nephritis and uveitis (TINU syndrome) in childhood

During the last two years we have observed three children, aged 12-15 years, who developed acute non-oliguric renal failure with concomitant uveitis. Acute interstitial nephritis with lympho-monocytic infiltrates was diagnosed in all cases by renal biopsy. While two patients went into spontaneous remission, renal function in the remaining child improved only after treatment with oral prednisone. Withdrawal of steroid medication was promptly followed by a relapse, necessitating steroid therapy for a total of 4 months. The clinical and histological findings were consonant with the so-called TINU syndrome. While the pathogenesis of this syndrome is unclear, the prognosis seems to be favorable and most cases resolve spontaneously. However, in some cases, prolonged therapy with corticosteroids may be required.