Flurbiprofen-associated acute tubulointerstitial nephritis

We report a case of biopsy-proven acute tubulointerstitial nephritis associated with a second course of flurbiprofen, a nonsteroidal anti-inflammatory drug of the propionic acid class. The clinical presentation and course was consistent with acute tubulointerstitial nephritis due to these agents.     

Biopsy-proven paediatric tubulointerstitial nephritis

Background

Tubulointerstitial nephritis (TIN) is an uncommon condition in which the aetiology, treatment and outcome is not well defined. We describe a large series of children with biopsy-proven TIN.

Methods

All children with biopsy-proven TIN presenting to our institution during a 23-year period were retrospectively reviewed for aetiology, symptoms, treatment, and long-term outcome.

Results

A total of 27 children (16 girls) were described. Median age was 12 years (range 8 months to 15 years). A potentially adverse drug reaction was found in 12 (44 %) and infection in 8 (30 %). In 13 (48 %) no initiating factor was identified. All but 1 patient were treated with corticosteroids owing to worsening kidney function and 4 patients with other immunosuppressive agents. Fifteen children (56 %) had an estimated glomerular filtration rate (eGFR) of less than 80 ml/min/1.73 m² at last follow-up. Fifteen of the 23 children investigated (65 %) had coexistent uveitis.

Conclusion

This series represents a subset of paediatric TIN patients in whom there was a clinical indication for a renal biopsy, hence presenting with more severe disease than previously reported. This group were more likely to have no identifiable underlying cause and an increased requirement for corticosteroid treatment. Furthermore, more than half of the cases developed chronic kidney disease (CKD) with impaired kidney function.

     

Hydatid disease and tubulointerstitial nephritis

Hydatid disease of the kidney is rare, particularly in the isolated form, and tubulointerstitial nephritis is an extremely uncommon manifestation of renal hydatidosis. Here is the report of a patient with isolated renal hydatid disease who presented with acute renal failure secondary to tubulointerstitial nephritis. The patient responded to the combination of albendazole, corticosteroids and total nephrectomy.     

Candidemia and granulomatous tubulointerstitial nephritis

Candida infection is a relatively common cause of nosocomial bloodstream infection in immunosuppressed patients. However, renal involvement is infrequent. Moreover, direct Candida identification on kidney biopsy is rarely possible. We present a case of renal insufficiency secondary to Candida albicans tubulointerstitial nephritis.     

IgG4-related tubulointerstitial nephritis

Tubulointerstitial nephritis (TIN) is a disease pattern with heterogeneous causes. Recently a specific subtype of autoimmune TIN, IgG4-related TIN, has been identified that is part of systemic IgG4-related disease/ autoimmune pancreatitis. On biopsy, this TIN shows an IgG4+ plasma cell-rich infiltrate, akin to the pancreatic tissue findings in autoimmune pancreatitis, and may show tubulointerstitial immune complex deposits. Notably, some cases may be mass-forming. Recognition of this specific type of TIN can guide appropriate patient therapy.     

Clarithromycin-induced granulomatous tubulointerstitial nephritis.

Acute interstitial nephritis is an important cause of acuterenal dysfunction, accounting for up to 15% of patients hospitalizedfor acute renal dysfunction. Drug-induced interstitial nephritisrepresents 4% of all cases studied histologically, with an estimatedfrequency of 8% [1]. We present a case of granulomatous interstitialnephritis in a 38-year-old woman prescribed clarithromycin forpharyngitis. A 38-year-old woman was admitted with a history of abnormalrenal function. She was seen by her     

Tuberculosis and tubulointerstitial nephritis: an intriguing puzzle

Classical renal tuberculosis is a well-known cause of urinary tract scarring and calcification, and sometimes renal dysfunction. In the past two decades there have been reports, particularly from the United Kingdom among immigrants from the Indian subcontinent, of a more insidiously progressive form of renal disease. Ultrasound shows small smooth kidneys, and histology reveals tubulointerstitial nephritis including granulomas but not acid-fast bacilli. Evidence is mounting that the underlying cause may be tuberculosis, but the mechanism remains obscure.     

Acute tubulointerstitial nephritis induced by glucosamine

Sir, I am concerned that Audimoolam and Bhandari [1] were     

Hereditary coproporphyria and chronic tubulointerstitial nephritis

A 41-year-old woman was admitted to our hospital because of abdominal pain, limb weakness, and red-wine-colored urine. Laboratory data showed renal insufficiency and hyperchloremic metabolic acidosis due to type 4 renal tubular acidosis. Clinical manifestations and investigation of porphyrins in her urine, erythrocytes, and feces established the diagnosis of hereditary coproporphyria (HCP). Renal biopsy revealed chronic tubulointerstitial nephritis. She was treated with corticosteroid, but her renal function showed no improvement. Although rare, renal involvement has been described in several types of porphyrias other than HCP. Previously reported cases of porphyrias with renal histology share the findings of chronic tubulointerstitial nephritis. To our knowledge, this is the first report of a patient with HCP presenting with renal involvement. Received: February 21, 2000 / Accepted: June 28, 2000     

Acute tubulointerstitial nephritis after wasp stings

A 61-year-old Caucasian man presented with acute renal failure after multiple wasp stings. The patient required dialysis support temporarily. Work-up failed to show rhabdomyolysis or hemolysis and a kidney biopsy revealed acute allergic interstitial nephritis. The patient's renal function recovered completely after a short course of steroid therapy. Acute renal failure after wasp stings is typically caused by acute tubular necrosis in the setting of hemolysis or rhabdomyolysis. Compared with previously reported cases of acute renal failure associated with bee stings, our patient is unique in that his renal failure was caused by a hypersensitivity reaction apparently to the wasp venom. © 2001 by the National Kidney Foundation, Inc.     

Predominant tubulointerstitial nephritis in a patient with systemic lupus nephritis

In most cases of systemic lupus erythematosus (SLE), glomerular lesions are the main renal complication. Although tubulointerstitial lesions are often associated with severe glomerular lesions, predominant or isolated tubulointerstitial injury in the presence of minimal glomerular abnormalities with SLE, so-called predominant tubulointerstitial lupus nephritis, is rare. Only ten cases are reported in the English literature. Herein, we describe the case of a 64-year-old man with SLE who presented with acute renal deterioration attributable to acute tubulointerstitial nephritis. Renal biopsy showed diffuse infiltration of inflammatory mononuclear cells in the interstitium and tubulitis without significant glomerular lesions. Immunofluorescence study revealed positive staining for IgG, C3, and C1q along the renal tubular basement membrane (TBM). Electron microscopy also showed electron-dense deposits in the TBM. Other causes of tubulointerstitial injury, such as drug use and infection, were ruled out. Taking these findings together with the presence of antitubular basement membrane antibody, predominant tubulointerstitial lupus nephritis was diagnosed. Treatment with oral corticosteroids for 6 weeks improved renal function. Even after tapering of the corticosteroid, renal function and serological markers of SLE activity have remained stable in this patient for more than 12 months.     

Acute tubulointerstitial nephritis in 21 Japanese children

PATIENTS AND METHODS: We studied 21 Japanese children aged 1.2 to 14.9 years with biopsy-proven acute tubulointerstitial nephritis (ATIN; 5 drug-induced, 7 infection-related, 3 tubulointerstitial nephritis and uveitis syndrome (TINU), and 6 unclassified) for clinical presentation, laboratory findings, and outcome to clarify the clinical features of the entity. All developed acute renal failure with peak BUN values from 25 to 164 mg/dl (mean 83 mg/dl) and peak serum creatinine values from 1.5 to 15.1 mg/dl (mean 6.5 mg/dl). All the 7 infection-related ATIN were associated with Yersinia pseudotuberculosis infection. Four of the 21 patients underwent dialysis therapy for anuria and 1 patient in the unclassified ATIN showed progression to chronic renal failure. RESULTS: In 20 patients, renal insufficiency lasted for 6 to 73 days: 5 drug-induced; median and ranges 25 (12-33) days, 7 infection-related; 15 (6-22) days, 3 TINU; 65 (55-73) days, and 5 unclassified; 24 (6-34) days. Oral steroid therapy was introduced to the 3 TINU patients because of the prolonged renal dysfunction. Although it was effective in all, 2 of them showed a deterioration of clinical symptoms or renal function after reducing the dosage of steroid. CONCLUSION: Consequently, TINU patients required a longer period of time for the improvement of renal function compared to the other etiologies.     

加强对小管间质性肾炎的研究

小管间质性肾炎(TIN)是病变主要在肾间质及小管的炎症性肾脏病,简称间质性肾炎(interstitialnephritis)。若将系统性疾病继发的TIN除外,西方国家统计它在慢性肾衰竭病例中约占20%～40%,是一种很需重视的肾脏病。原发性TIN现常被分为急性及慢性两大类,前者包括急性药物过敏性TIN、急性感染相关性TIN(微生物侵袭肾间质导致的化脓性炎症除外)及急性特发性TIN等;后者包括药物(含马兜铃酸中草药、镇痛药、环孢素A、顺铂、碳酸锂等)、重金属(镉、铅等)、放射线等理化因素引起的TIN及原因未明的TIN(如巴尔干肾病)。但是,至今TIN在发病…