Abstract
Abstract Granulomatous interstitial nephritis (GIN) is a rare histological entity with multiple aetiologies. Infectious causes like tuberculosis predominate in the Indian subcontinent, where as drugs, sarcoidosis and vasculitis are common causes of GIN in the western world. We report a case of a 46 year old man who had been receiving phenytoin for five years, and presented to us with vomitings and oliguria. His evaluation revealed anemia, eosinophilia, azotemia, hypocalcemia and eosinophiluria. He had elevated serum Immunoglobulin E levels. Ultrasound revealed normal kidney size. Renal biopsy done showed non-caseating epitheloid cell granulomas with interstitial infiltration of lymphocytes and eosinophils, indicative of GIN. The common causes of GIN were ruled out and the diagnosis of phenytoin induced GIN was made. Phenytoin was replaced with sodium valporate. Patient received few sessions of haemodialysis and oral prednisolone, following which he showed considerable improvement. GIN is a treatable cause of renal failure and responds to steroids irrespective of the cause. Also medications as a cause of renal disease in patients presenting with acute renal failure must be excluded, even in India for early and correct diagnosis.
Published Version
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