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Granulomatous interstitial nephritis.

Shah S, Carter-Monroe N, Atta MG - Clin Kidney J (2015)

Bottom Line: It is also associated with NSAIDs and granulomatous disorders such as sarcoidosis, tuberculosis, fungal infections, and granulomatosis with polyangiitis.Retrospective data and clinical experience suggest that removal of the offending agent in conjunction with corticosteroid therapy often results in improvement in renal function.These findings were attributed to doxycycline treatment of his wound infection.

View Article: PubMed Central - PubMed

Affiliation: Johns Hopkins University , Baltimore, MD , USA.

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.

No MeSH data available.


Related in: MedlinePlus

Hematoxylin and eosin stain at ×400 magnification on light microscopy demonstrating a poorly formed granuloma with foreign body-type giant cells.
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SFV053F2: Hematoxylin and eosin stain at ×400 magnification on light microscopy demonstrating a poorly formed granuloma with foreign body-type giant cells.

Mentions: A kidney biopsy was performed. Light microscopy demonstrated relatively uninvolved glomeruli and marked diffuse interstitial inflammation composed of activated lymphocytes, plasma cells and numerous eosinophils (>50/hpf) with frequent foreign body giant cells associated with non-caseating granulomas (Figures 1 and 2). There was moderate acute tubular injury and presumed mild interstitial fibrosis. Special stains for acid-fast bacilli, bacteria (Brown & Hopps) and fungi (GMS) were negative. Immunofluorescence revealed non-specific findings. Electron microscopy showed scattered immune deposits possibly corresponding to IgM on immunofluorescence, suggesting an immune-mediated process; however, the extensive granulomatous inflammation was considered the prevailing pathologic process. He was diagnosed with severe AIN with numerous eosinophils and foreign body giant cell granulomas, secondary to doxycycline.Fig. 1.


Granulomatous interstitial nephritis.

Shah S, Carter-Monroe N, Atta MG - Clin Kidney J (2015)

Hematoxylin and eosin stain at ×400 magnification on light microscopy demonstrating a poorly formed granuloma with foreign body-type giant cells.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4581373&req=5

SFV053F2: Hematoxylin and eosin stain at ×400 magnification on light microscopy demonstrating a poorly formed granuloma with foreign body-type giant cells.
Mentions: A kidney biopsy was performed. Light microscopy demonstrated relatively uninvolved glomeruli and marked diffuse interstitial inflammation composed of activated lymphocytes, plasma cells and numerous eosinophils (>50/hpf) with frequent foreign body giant cells associated with non-caseating granulomas (Figures 1 and 2). There was moderate acute tubular injury and presumed mild interstitial fibrosis. Special stains for acid-fast bacilli, bacteria (Brown & Hopps) and fungi (GMS) were negative. Immunofluorescence revealed non-specific findings. Electron microscopy showed scattered immune deposits possibly corresponding to IgM on immunofluorescence, suggesting an immune-mediated process; however, the extensive granulomatous inflammation was considered the prevailing pathologic process. He was diagnosed with severe AIN with numerous eosinophils and foreign body giant cell granulomas, secondary to doxycycline.Fig. 1.

Bottom Line: It is also associated with NSAIDs and granulomatous disorders such as sarcoidosis, tuberculosis, fungal infections, and granulomatosis with polyangiitis.Retrospective data and clinical experience suggest that removal of the offending agent in conjunction with corticosteroid therapy often results in improvement in renal function.These findings were attributed to doxycycline treatment of his wound infection.

View Article: PubMed Central - PubMed

Affiliation: Johns Hopkins University , Baltimore, MD , USA.

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.

No MeSH data available.


Related in: MedlinePlus