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Overlapping presentation of fungal tubulointerstitial nephritis in an immunosuppressed pediatric patient.

Tee JB, Reznik V, Krous HF - Pediatr. Nephrol. (2009)

Bottom Line: With the expanding use of immunosuppressive therapies and broad-spectrum antibiotics, Candida species has become an increasingly important cause of infections, particularly in the presence of anti-tumor necrosis factor-alpha therapy.We report the case of a 17-year-old female with ulcerative colitis who developed oliguric renal failure following immunosuppressive and nephrotoxic therapy.Although urine cultures and urinary tract imaging were negative in the face of fungemia, renal biopsy was the key to establishing the diagnosis of fungal tubulo-interstitial nephritis as the primary reversible cause of the renal failure.

View Article: PubMed Central - PubMed

Affiliation: Division of Pediatric Nephrology, Department of Pediatrics, University of Calgary, Calgary, AB, Canada. james.tee@alumni.utoronto.ca

ABSTRACT
With the expanding use of immunosuppressive therapies and broad-spectrum antibiotics, Candida species has become an increasingly important cause of infections, particularly in the presence of anti-tumor necrosis factor-alpha therapy. We report the case of a 17-year-old female with ulcerative colitis who developed oliguric renal failure following immunosuppressive and nephrotoxic therapy. Although urine cultures and urinary tract imaging were negative in the face of fungemia, renal biopsy was the key to establishing the diagnosis of fungal tubulo-interstitial nephritis as the primary reversible cause of the renal failure.

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Masson’s trichrome staining of the kidney reveals severe tubulointerstitial disease and a relatively normal glomerulus. Magnification ×100. Insert Fungal organisms (arrows) and neutrophils are present in the tubules and adjacent interstitium. Periodic acid-Schiff stain, magnification ×200
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Fig1: Masson’s trichrome staining of the kidney reveals severe tubulointerstitial disease and a relatively normal glomerulus. Magnification ×100. Insert Fungal organisms (arrows) and neutrophils are present in the tubules and adjacent interstitium. Periodic acid-Schiff stain, magnification ×200

Mentions: The renal biopsy showed severe active tubulointerstitial nephritis with budding yeast forms and pseudohyphae consistent with Candida that were visualized within the tubules (Fig. 1). The interstitium and tubules were infiltrated with numerous neutrophils but not eosinophils. The tubular basement membranes were disrupted, indicating likely evolution to focal renal scarring. The glomeruli were essentially normal. Neither vasculitis nor granulomas were detected. Immunofluorescence microscopy was negative for immunoglobulins, complement, and fibrin.Fig. 1


Overlapping presentation of fungal tubulointerstitial nephritis in an immunosuppressed pediatric patient.

Tee JB, Reznik V, Krous HF - Pediatr. Nephrol. (2009)

Masson’s trichrome staining of the kidney reveals severe tubulointerstitial disease and a relatively normal glomerulus. Magnification ×100. Insert Fungal organisms (arrows) and neutrophils are present in the tubules and adjacent interstitium. Periodic acid-Schiff stain, magnification ×200
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2697366&req=5

Fig1: Masson’s trichrome staining of the kidney reveals severe tubulointerstitial disease and a relatively normal glomerulus. Magnification ×100. Insert Fungal organisms (arrows) and neutrophils are present in the tubules and adjacent interstitium. Periodic acid-Schiff stain, magnification ×200
Mentions: The renal biopsy showed severe active tubulointerstitial nephritis with budding yeast forms and pseudohyphae consistent with Candida that were visualized within the tubules (Fig. 1). The interstitium and tubules were infiltrated with numerous neutrophils but not eosinophils. The tubular basement membranes were disrupted, indicating likely evolution to focal renal scarring. The glomeruli were essentially normal. Neither vasculitis nor granulomas were detected. Immunofluorescence microscopy was negative for immunoglobulins, complement, and fibrin.Fig. 1

Bottom Line: With the expanding use of immunosuppressive therapies and broad-spectrum antibiotics, Candida species has become an increasingly important cause of infections, particularly in the presence of anti-tumor necrosis factor-alpha therapy.We report the case of a 17-year-old female with ulcerative colitis who developed oliguric renal failure following immunosuppressive and nephrotoxic therapy.Although urine cultures and urinary tract imaging were negative in the face of fungemia, renal biopsy was the key to establishing the diagnosis of fungal tubulo-interstitial nephritis as the primary reversible cause of the renal failure.

View Article: PubMed Central - PubMed

Affiliation: Division of Pediatric Nephrology, Department of Pediatrics, University of Calgary, Calgary, AB, Canada. james.tee@alumni.utoronto.ca

ABSTRACT
With the expanding use of immunosuppressive therapies and broad-spectrum antibiotics, Candida species has become an increasingly important cause of infections, particularly in the presence of anti-tumor necrosis factor-alpha therapy. We report the case of a 17-year-old female with ulcerative colitis who developed oliguric renal failure following immunosuppressive and nephrotoxic therapy. Although urine cultures and urinary tract imaging were negative in the face of fungemia, renal biopsy was the key to establishing the diagnosis of fungal tubulo-interstitial nephritis as the primary reversible cause of the renal failure.

Show MeSH
Related in: MedlinePlus