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Etiological diagnosis of granulomatous tubulointerstitial nephritis in the tropics.

Agrawal V, Kaul A, Prasad N, Sharma K, Agarwal V - Clin Kidney J (2015)

Bottom Line: We studied the etiology of GIN and compared the clinical and histological features and outcome in different etiologies at a tertiary care center in North India.Necrosis in granuloma, demonstration of acid fast bacilli, blood interferon gamma release assay and urine culture is not sensitive for the diagnosis of tuberculosis in GIN.Our findings suggest that tissue PCR for tuberculosis performed in an appropriate clinical setting is useful in the diagnostic evaluation of GIN.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology , Sanjay Gandhi Post Graduate Institute of Medical Sciences , Lucknow, Uttar Pradesh , India.

ABSTRACT

Background: Granulomatous tubulointerstitial nephritis (GIN) is common due to infections, drugs or sarcoidosis. However, the cause is often difficult to establish and the studies are limited. We studied the etiology of GIN and compared the clinical and histological features and outcome in different etiologies at a tertiary care center in North India.

Methods: Renaö biopsies from GIN cases diagnosed from January 2004 to April 2014 were retrieved. Stain for acid fast bacilli was performed in all biopsies. Etiological diagnosis was based on clinical features, extra-renal manifestations, radiology, history of drug intake and demonstration of infective agent. Tissue PCR for tubercular DNA was performed in seven biopsies.

Results: Seventeen GIN patients [mean age 35 ± 15 years; males 11] were identified. Tuberculosis was the commonest etiology followed by idiopathic, sarcoidosis and fungal. Both tuberculosis and sarcoidosis patients presented with subnephrotic proteinuria and raised serum creatinine. Acid fast bacilli were demonstrated in 1/9 and necrosis was demonstrated in 3/9 granulomas in tuberculosis. Tissue PCR for tubercular DNA was positive in six TB patients and negative in one sarcoidosis patient. Patients responded well to appropriate therapy.

Conclusion: Etiological diagnosis of GIN is essential for timely and appropriate therapy. Tuberculosis is the commonest etiology (53%) in the tropics. Necrosis in granuloma, demonstration of acid fast bacilli, blood interferon gamma release assay and urine culture is not sensitive for the diagnosis of tuberculosis in GIN. Our findings suggest that tissue PCR for tuberculosis performed in an appropriate clinical setting is useful in the diagnostic evaluation of GIN.

No MeSH data available.


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Agarose gel picture of multiplex PCR for Mycobacterium tuberculosis: Lane 1: 100 base pair DNA marker, Lane 2: positive control, Lane 3–7: positive renal biopsy tissue, L8: negative control.
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SFV071F1: Agarose gel picture of multiplex PCR for Mycobacterium tuberculosis: Lane 1: 100 base pair DNA marker, Lane 2: positive control, Lane 3–7: positive renal biopsy tissue, L8: negative control.

Mentions: A diagnosis of tuberculosis was made after demonstration of AFB in renal biopsy (n = 1) or on fine needle aspiration smears from the enlarged cervical lymph nodes in four patients. Clinical features and radiology were useful in making a diagnosis in the rest of the patients. Multiplex PCR for tubercular DNA in renal biopsies was performed in six patients and was positive in all (Figure 1). It was negative in the case of sarcoidosis. The patients with tuberculosis presented with advanced (n = 7) to mild renal failure (n = 2) and subnephrotic proteinuria (Table 1). Respiratory symptoms were present in three and hypertension was present in six patients. On histology, AFB was seen in only one renal biopsy in a patient on steroids. Necrosis in the granuloma was noted in three biopsies (Table 2). Blood interferon gamma release assay (QuantiFERON-TB Gold) for tuberculosis performed in six was positive in one patient. Urine culture for AFB was negative in all.Table 2.


Etiological diagnosis of granulomatous tubulointerstitial nephritis in the tropics.

Agrawal V, Kaul A, Prasad N, Sharma K, Agarwal V - Clin Kidney J (2015)

Agarose gel picture of multiplex PCR for Mycobacterium tuberculosis: Lane 1: 100 base pair DNA marker, Lane 2: positive control, Lane 3–7: positive renal biopsy tissue, L8: negative control.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4581389&req=5

SFV071F1: Agarose gel picture of multiplex PCR for Mycobacterium tuberculosis: Lane 1: 100 base pair DNA marker, Lane 2: positive control, Lane 3–7: positive renal biopsy tissue, L8: negative control.
Mentions: A diagnosis of tuberculosis was made after demonstration of AFB in renal biopsy (n = 1) or on fine needle aspiration smears from the enlarged cervical lymph nodes in four patients. Clinical features and radiology were useful in making a diagnosis in the rest of the patients. Multiplex PCR for tubercular DNA in renal biopsies was performed in six patients and was positive in all (Figure 1). It was negative in the case of sarcoidosis. The patients with tuberculosis presented with advanced (n = 7) to mild renal failure (n = 2) and subnephrotic proteinuria (Table 1). Respiratory symptoms were present in three and hypertension was present in six patients. On histology, AFB was seen in only one renal biopsy in a patient on steroids. Necrosis in the granuloma was noted in three biopsies (Table 2). Blood interferon gamma release assay (QuantiFERON-TB Gold) for tuberculosis performed in six was positive in one patient. Urine culture for AFB was negative in all.Table 2.

Bottom Line: We studied the etiology of GIN and compared the clinical and histological features and outcome in different etiologies at a tertiary care center in North India.Necrosis in granuloma, demonstration of acid fast bacilli, blood interferon gamma release assay and urine culture is not sensitive for the diagnosis of tuberculosis in GIN.Our findings suggest that tissue PCR for tuberculosis performed in an appropriate clinical setting is useful in the diagnostic evaluation of GIN.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology , Sanjay Gandhi Post Graduate Institute of Medical Sciences , Lucknow, Uttar Pradesh , India.

ABSTRACT

Background: Granulomatous tubulointerstitial nephritis (GIN) is common due to infections, drugs or sarcoidosis. However, the cause is often difficult to establish and the studies are limited. We studied the etiology of GIN and compared the clinical and histological features and outcome in different etiologies at a tertiary care center in North India.

Methods: Renaö biopsies from GIN cases diagnosed from January 2004 to April 2014 were retrieved. Stain for acid fast bacilli was performed in all biopsies. Etiological diagnosis was based on clinical features, extra-renal manifestations, radiology, history of drug intake and demonstration of infective agent. Tissue PCR for tubercular DNA was performed in seven biopsies.

Results: Seventeen GIN patients [mean age 35 ± 15 years; males 11] were identified. Tuberculosis was the commonest etiology followed by idiopathic, sarcoidosis and fungal. Both tuberculosis and sarcoidosis patients presented with subnephrotic proteinuria and raised serum creatinine. Acid fast bacilli were demonstrated in 1/9 and necrosis was demonstrated in 3/9 granulomas in tuberculosis. Tissue PCR for tubercular DNA was positive in six TB patients and negative in one sarcoidosis patient. Patients responded well to appropriate therapy.

Conclusion: Etiological diagnosis of GIN is essential for timely and appropriate therapy. Tuberculosis is the commonest etiology (53%) in the tropics. Necrosis in granuloma, demonstration of acid fast bacilli, blood interferon gamma release assay and urine culture is not sensitive for the diagnosis of tuberculosis in GIN. Our findings suggest that tissue PCR for tuberculosis performed in an appropriate clinical setting is useful in the diagnostic evaluation of GIN.

No MeSH data available.


Related in: MedlinePlus