Case Of Interstitial Nephritis Research Articles

Result of 10 Years of Experience in Echo-Guided Kidney Biopsy Punctures in the Nephrology Department of the Martigues Hospital Center, France

Introduction: Percutaneous renal biopsy (PRB) is an essential procedure for the diagnosis and therapeutic management of many primary or secondary nephropathies. Objectives: To identify the indications, to determine the profile of the diagnosed nephropathies and to evaluate the short-term complications related to the practice of echo-guided PRB at the Martigues hospital center. Methodology: This was a retrospective and descriptive study carried out on the records of patients who underwent echo-guided native kidney biopsy from January 1, 2010 to December 31, 2019 in the nephrology department of the Martigues Hospital. Results: The analysis of 123 cases of echo-guided PRB involved 76 men and 47 women with a sex ratio of 1.6. The mean age was 55.92 ± 17.80 with age extremes of 16 and 87 years. Glomerular syndromes were the main indication with 42 cases of nephrotic syndrome (34.1%), 15 cases of nephritic syndrome (12.2%), 11 cases of rapidly progressive glomerulonephritis syndrome (8.9%), and 6 cases of recurrent macroscopic hematuria syndrome (4.9%). The histological findings were 47 cases of primary glomerular lesions (38.3%), 32 cases of nephroangiosclerosis lesions (26%), 24 cases of secondary glomerulopathy (19.5%), 9 cases of interstitial nephritis (7.3%), 2 cases of myelomatous nephropathy (1.6%), and 9 cases (7.3%) of unclassified histological lesions. Twenty-two hypertensive patients (40.7%) had nephroangiosclerosis lesions (p = 0.001). The follow-up was simple in 119 patients (96.7%). Macroscopic hematuria was noted in 4 patients (3.3%). It was associated with a perirenal hematoma in 2 patients including 1 transfused case. Conclusion: Our data provide an important contribution to the understanding of the prevalence and clinical presentation of renal diseases in the nephrology department of the Martigues hospital center.

P0139RETROSPECTIVE ANALYSIS OF RENAL PATHOLOGY AND CYTOGENETIC EXAMINATION IN PATIENTS WITH MULTIPLE MYELOMA WITH RENAL IMPAIRMENT

Abstract Background and Aims Renal impairment is one of the common implications in multiple myeloma. But the relationships between the renal pathology and cytogenetic features are not fully understood. To explore the renal pathology and cytogenetic features in patients of multiple myeloma with renal impairment. Method Retrospective of our hospital from January 2009 to January 2019, newly diagnosed multiple myeloma patients with renal impairment. The relationship between the results of Fluorescence in situ hybridization (FISH) and renal pathological findings was analyzed. Statistical analysis was performed using SPSS 20.0. Results A total of 20 patients underwent renal biopsy, included 12 males and 8 females. FISH result showed that there were 7 cases of interstitial nephritis, 3 of them were negative for FISH, and the remaining that IgH rearrangement, 1q21 amplification, RB1 deletion, D13S319 deletion, and P53 deletion detection rates were 42.86%, 28.57%, 28.57%, 28.57% and 14.29%. The incidence was lower, which was statistically significant (P<0.01). There were 6 cases of cast nephropathy, IgH rearrangement, 1q21 amplification, RB1 deletion, D13S319 deletion, and P53 deletion detection rates were 66.67%, 50%, 66.67%, 50% and 0%. Compared with the total probe positive rate, there was no statistical significance (P>0.05). There were 4 cases of acute tubular necrosis, IgH rearrangement, 1q21 amplification, RB1 deletion, D13S319 deletion, and P53 deletion detection rates were 100%, 50%, 50%, 25% and 25%, respectively. Compared with the total probe positive rate, there was no statistical significance (P>0.05). There are 1 of amyloidosis and 1 of tubular nephropathy with amyloidosis were positive for 5 probes. One case of light chain deposition disease was positive for RB1 gene deletion + D13S319 gene deletion. Conclusion FISH in patients with different renal pathological changes is characterized by heterogeneity, which can be used to predict the risk of renal damage and speculate on possible renal pathological types to guide prognosis.

Minimal change disease associated with anti-PD1 immunotherapy: a case report

BackgroundOncologic immunotherapy is a form of therapy intended to reactivate the immune response to tumor cells using agents that modulate immune checkpoints, such as programmed cell death protein 1 and its ligand (PD-1/PD-L), and cytotoxic T-lymphocyte-associated antigen 4. Along with activation of the immune system to tumors, immune-mediated kidney side effects have been reported, most of which are cases of interstitial nephritis. Glomerular disease, however, appears rare.Case presentationHerein, we describe a patient with nephrotic syndrome related to treatment with an anti-PD1 antibody for Hodgkin lymphoma. Following the third dose of anti-PD1 antibody, the patient developed massive proteinuria and nephrotic syndrome. Kidney biopsy showed diffuse podocyte foot process effacement upon electron microscopy, which was consistent with minimal change disease. Corticosteroid treatment yielded full and rapid remission of nephrotic syndrome in 1 month.ConclusionThe present case suggests an association between anti-PD1 therapeutic immune activation and the development of nephrotic syndrome. Given the increasing prevalence of oncologic immunotherapy, patients should be routinely monitored for kidney side effects associated with these agents.

The incidence of IgG4-positive plasma cells staining TIN in patients with biopsy-proven tubulointerstitial nephritis

AimIgG4 disease is rare. However, IgG4 tubulointerstitial nephritis (TIN) is the most common renal manifestation. IgG4 disease is usually associated with elevated serum IgG4 levels and other organ involvement, low-density...

Lansoprazole-induced acute allergic interstitial nephritis in a renal transplant recipient: a case report

Drug-induced interstitial nephritis is one of the causes of graft dysfunction in renal transplant recipients. Although commonly implicated as a cause of drug-induced interstitial nephritis in the general population, proton pump inhibitor-induced interstitial nephritis has not yet been reported in renal transplant recipients. Trimethoprim-sulfamethoxazole is responsible for most cases of interstitial nephritis in this population. Here, we describe the first case of proton pump inhibitor-related interstitial nephritis in a renal transplant recipient.

An autopsy case of multicentric Castleman’s disease associated with interstitial nephritis and secondary AA amyloidosis

It is quite rare to diagnose interstitial nephritis and secondary amyloidosis during the course of Castleman's disease (CD). To our knowledge, only four cases of interstitial nephritis and 44 cases of amyloidosis associated with CD have been reported to date. A 51-year-old man with a 9-year history of hypergammaglobulinemia was diagnosed with multicentric Castleman's disease of the plasma cell type. At the age of 55, it was complicated with interstitial nephritis, which was successfully treated with steroids and cyclophosphamide. At the age of 58, he was diagnosed with secondary AA amyloidosis and thrombocytopenia, which led to a fatal brain hemorrhage. The plasma cell type of this illness involves a relatively high incidence of amyloidosis, and the present patient suggests that some cases of multicentric Castleman's disease could proceed rapidly, be unresponsive to steroid therapy, and may have a fatal outcome.

Acute renal failure due to interstitial nephritis after intravesical instillation of BCG

Intravesical chemotherapy with bacilli Calmette-Guerin (BCG) has been an established therapy for preventing recurrence of, and for treatment of, superficial transitional cell carcinoma of the bladder, but it is not without side effects. A variety of renal complications have been reported and attributed to mycobacterial infection. Although renal complications are uncommon, several cases of interstitial nephritis (with or without granulomas) and mesangial glomerulonephritis have been reported. We report a 76-year-old male patient who developed acute renal failure due to interstitial nephritis after intravesical instillation of BCG. Corticosteroids may serve the recovery of renal function without concomitant use of anti-tubercular therapy, provided systemic signs and mycobacterial infection are absent. Serum creatinine should be checked in at-risk patients in order to detect this complication early.

Two cases of interstitial nephritis with primary Sjögren's syndrome successfully treated by steroid therapy

Two cases of interstitial nephritis with primary Sjögren's syndrome successfully treated by steroid therapy

Primary chronic interstitial nephritis in Crohn's disease

Background & Aims: In Crohn's disease, cases of interstitial nephritis with renal failure have been reported in connection with the use of mesalamine. Methods: We observed 4 patients with severe interstitial nephritis proven by examination of kidney biopsy specimens. Renal failure was discovered before or simultaneously with the diagnosis of Crohn's disease, and patients were not treated with mesalamine. Impairment of renal function progressed to end-stage renal failure in 3 of the 4 patients. Results: Our results show that the kidney can be an extraintestinal target of Crohn's disease. Conclusions: Several unanswered questions remain concerning the frequency of interstitial nephritis in patients with Crohn's disease, as well as the exact role of mesalamine in the development of chronic interstitial nephritis.GASTROENTEROLOGY 2002;123:1436-1440

A case of interstitial nephritis on clozapine

A case of interstitial nephritis on clozapine

Mesalazine-associated interstitial nephritis

When used for oral treatment of inflammatory bowel disease, Asacol (a coated form of mesalazine = 5-aminosalicylic acid) can cause interstitial nephritis. The spectrum of severity, frequency of occurrence and the best renal function test to detect this complication are not known. The value of immunosuppression in addition to drug withdrawal is similarly undetermined. Four cases of interstitial nephritis which occurred in association with oral Asacol treatment are presented and a further 12 cases who received similar treatment are reviewed. Clinical trials published previously were scrutinized to assess the frequency of impaired renal function. The available evidence suggests that renal impairment of any severity may occur in up to 1 in 100 patients, but that clinically significant interstitial nephritis occurs in less than 1 in 500 patients. This is most reliably detected by an elevated serum creatinine concentration. If the diagnosis of nephrotoxicity is delayed until 18 months after commencement of medication, restoration of renal function, which is seen on withdrawal of medication alone up to 10 months, does not occur and there is no evidence to date to indicate that addition of immunosuppression confers any significant advantage at this later stage. It is suggested that serum creatinine concentration should be measured each month for the first 3 months of treatment, 3-monthly for the remainder of the first year and annually thereafter. The use of concurrent immunosuppressive therapy may necessitate extension to the period of intensive monitoring. Any elevation of serum creatinine which cannot be related to a relapse of inflammatory bowel disease should prompt immediate withdrawal of Asacol and related medications and substitution of alternative therapy. Neither the lack of urinary abnormalities on routine testing nor the absence of clinical or laboratory features of drug allergy can be relied upon to rule out interstitial nephritis during oral therapy with these drugs.

Abdominal pain in sickle cell disease: the role of CT.

Patients with either homozygous or heterozygous sickle cell disease may have frequent episodes of abdominal pain and/or fever of uncertain cause. While many of these episodes represent a so-called sterile crisis, the possibility of gross organ infarction and rupture, infection, or other complication cannot be ignored. Computed tomography (CT) was used to evaluate 30 such patients. Virtually all patients had splenic abnormalities, which could be considered clinically significant (rupture, hemorrhage) or insignificant (calcified spleen). In four patients hepatic abnormalities were found, including one case of multiple liver infarction, one of hepatic abscess, and two of retained intrahepatic gallstones after cholecystectomy. Two patients had significant acute renal abnormalities, including one case of interstitial nephritis and one of renal vein thrombosis. One patient had a ruptured periappendiceal abscess and one a pericolonic abscess. One patient had an abscess around a total hip replacement. CT was found to be an excellent and relatively noninvasive means of both initial investigation and subsequent follow-up.

Panorama- und Gestaltwandel der Infektionskrankheiten im Sektionsgut des Pathologischen Institutes der Universität Heidelberg während drei Dezennien Chemotherapie

Previous studies have demonstrated changes in the frequency and pathomorphosis of infectious diseases in the initial years following the introduction of sulfonamides and antibiotics as compared to the years prior to their introduction. The object of this study is to determine whether the intervening decades have produced further such changes in view of the extensive use of highly effective chemotherapeutical agents and new vaccines. For this purpose, autopsy reports involving infectious diseases from 1930 to 1934 in the department of pathology of the University of Heidelberg were compared with reports from the years 1950 to 1954 and 1968 to 1972. The number of cases of bronchial pneumonia, meningitis, enterocolitis and syphilis were found to have decreased since the introduction of chemotherapy. The number of cases of lobar pneumonia increased slightly, but not enough to be of statistical significance. An increase was observed in the number of cases of interstitial nephritis and hepatitis. Osteomyelitis, typhus fever, dysentery, viral pneumonia and the childhood diseases diphtheria, scarlet fever, measles and poliomyelitis were rarely reported. Further morphopathological changes since the introduction of chemotherapy were evident in some infectious diseases such as syphilis and scarlet fever. The statistical evidence from these autopsy reports verifies that changes in the frequency and morphopathology of infectious diseases which were noted during the early years following the introduction of chemotherapy are still taking place today.

Etiologic factors in lead nephropathy.

The rare occurrence of lead nephropathy in widely differing circumstances has suggested that additional causative factors might be required for its production. Seventeen cases of interstitial nephritis associated with severe chronic lead poisoning were reviewed in an attempt to identify these. Data suggested that alcoholism and preexistent hypertension, and also previous or minor urinary tract disease, may potentiate the injurious effects of lead. We recommend that the diagnosis of lead nephropathy should be a positive one, not one of exclusion, and that stored lead should be removed, particularly in persons with hypertension or previous urinary tract diseases.

STUDY FOR ETIOLOGY OF NEPHRITIS. I. CLINICAL STUDY.

1) In more than half of the cases which were admitted to our hospital within 3 months after developing acute nephritis, streptococcal infection was recognized. Among 7 cases in which streptococci were isolated ; group A type 12 β-hemolytic streptococci were found in 4 cases ; group A un-identifiable type in one case ; un-identifiable group in one case, from which it can be deduced that infection of streptococci, especially that of group A type 12 has close relation to the development of nephritis. There is a case in which nephritic symptom was revealed by the alleged infection of Influenza B more than 10 years after conva-lescnce of acute nephritis. 2) As to the case of chronic nephritis, except the time of exacerbation, no streptococcal infection was proved both in those initiated by acute nephritis and in those not apparently initiated by acute nephritis Therefore, it seems that there is some other reason for its aggravation. 3) As to the exacerbated cases of chronic nephritis, though at the time of exacerbation of chronic nephritis initiated by acute nephritis, streptococcal infection could not be proved, in many cases nephritis developed within a week after infection. In one case, however, exacerbation was recognized to be resulted from the alleged infection of Influenza B. Among exacerbation cases of chronic nephritis not apparently initiated by acute nephritis, in two cases out of three, preceding infection of streptococci was proved, while in the remaining one, latent stage lasted for 3 weeks. From these facts it may be concluded that the exacerbation of chronic nephritis results either from streptococcal infection or from infection of something other than streptococci, and mechanism of development of nephrites in these two categories is different. 4) As to the group of nephrotic syndrome, the cases in which preceding infection was recognized were few and no streptococci were isolated. It seems that the relationship between the development of this disease and streptococcal infection is not quite close. There is only one case of interstitial nephritis in which though preceding infection was recognized, no streptococcal infection was proved. 5) Neither aggravation nor improvement of nephritis resulted from tonsillectomy operated upon nephritic patients. Between the temporary worsening of urinary findings following the tonsillectomy and the isolation or non-isolation of streptococci from extracted tonsil culture, there seemed to be no interrelation whatsoever. Therefore, it seems that tonsil itself gives some impact upon kidney.