Diagnosis Of Granulomatous Interstitial Nephritis Research Articles

Difficulties in the differential diagnosis of granulomatous interstitial nephritis

Difficulties in the differential diagnosis of granulomatous interstitial nephritis

POS-475 GRANULOMATOUS INTERTITIAL NEPHRITIS : A SERIE OF FIVE PATIENTS

Granulomatous interstitial nephritis (GIN) is a rare histologic diagnosis.The cause is often difficult to establish and the studies are limited.This serie reported the presenting features, associated conditions, treatment, and outcomes of patients with a diagnosis of GIN. From 2005 to 2020 , we analysed cases of acute intertitial nephritis in the departement of nephrology of Fatouma Bourguiba Monastir University Hospital. From 17 cases of acute intertitial glomerulonephritis, five patients had granulomatous interstitial nephritis : three cases were associated with sarcoidosis, two were idiopathic. All the patients were femele.The median age of patients was 57 years [34- 77 years]. All patients presented with advanced renal failure (median estimated creatinine clearance 9 ml/min) and minimal proteinuria ( the mean was 0.9 g/day ) without hematuria. Hypercalcemia was present in 2 patients. Pulmonary involvement was present in one case, uveitis and pancreatitis were identified respectively in two cases and one case. Renal biopsy revealed granulomatous interstitial nephritis lesions in all patients. Corticosteroid therapy using prednisolone 1 mg/kg per day was used in all patients. Two patients had methylprednisolone pulse before oral corticosteroid therapy. MMF was associated with corticosteroids in one case. All patients improved their renal function. The median estimated creatinine clearance was 25 ml/min after 6 months. Two patients had normalized their renal fonction. Granulomatous interstitial nephritis may be the first manifestation of a systemic disease . Histologic features do not seem to distinguish the underlying cause of GIN. Corticosteroids therapy seems to be efficient and must be introduced early to prevent progression to chronic renal failure and it is associated with a good prognosis.

Quiz: Acute Kidney Injury in a Patient on a TNF-α Blocking Agent

Quiz: Acute Kidney Injury in a Patient on a TNF-α Blocking Agent

Renal allograft granulomatous interstitial nephritis: observations of an uncommon injury pattern in 22 transplant recipients

Background: Granulomatous interstitial nephritis (GIN) is uncommon in native kidneys, and descriptions in allografts are few. We report clinical and pathologic findings in 22 allograft recipients with GIN identified in renal allograft biopsies and nephrectomies. Methods: Renal allografts with GIN were retrieved from the pathology files of two academic medical centers. Available clinical and pathologic data were compiled retrospectively for a 23-year period. Results: GIN was present in 23 specimens from 22 patients (15 males and 7 females) with allograft dysfunction [serum creatinine averaged 3.3 mg/dL (range 1.4–7.8)], at a mean age of 48 years (range 22–77). GIN was identified in 0.3% of biopsies at a mean of 552 days post transplantation (range 10–5898). GIN was due to viral (5), bacterial (5) and fungal (2) infections in 12 (54.5%), and drug exposure was the likely cause in 5 cases (22.7%). One had recurrent granulomatosis with polyangiitis. In 4 cases, no firm etiology of GIN was established. Of 18 patients with follow up data, 33.3% had a complete response to therapy, 44.5% had a partial response and 22.2% developed graft loss due to fungal and E. coli infections. All responders had graft survival for more than 1 year after diagnosis of GIN. Conclusions: Allograft GIN is associated with a spectrum of etiologic agents and was identified in 0.3% of biopsies. Graft failure occurred in 22% of this series, due to fungal and bacterial GIN; however, most had complete or partial dysfunction reversal and long–term graft survival after appropriate therapy.

Granulomatous Interstitial Nephritis as a Manifestation of Crohn Disease

Granulomatous interstitial nephritis is a rare extraintestinal manifestation of Crohn disease that has been described previously in 4 patients. We report a 23-year-old man with a history of Crohn disease since age 6 years who was admitted to the hospital for weight loss, fever, and bloody diarrhea in the midst of a recent flare up during the past 2 months. Investigations revealed anemia, high erythrocyte sedimentation rate, high C-reactive protein level, and an elevated serum creatinine level. Histopathologic examination of tissue specimens obtained at renal biopsy demonstrated granulomatous interstitial nephritis. Crohn disease needs to be in the differential diagnosis of granulomatous interstitial nephritis and can be a manifestation of drug allergy or the Crohn disease itself.

Malakoplakia of the Kidney

Malakoplakia is a rare inflammatory disease associated with Escherichia coli infection. 1 von Hansemann D. Uber malakoplakia der harnblase. Virchows Arch A Pathol Anat Histopathol. 1903; 173: 302-308 Crossref Scopus (174) Google Scholar Despite some characteristic histological features, including the presence of large histiocytes with clusters of Michaelis-Gutmann (MG) bodies, malakoplakia of the kidney is difficult to diagnose because of its rarity and varying histological picture. We report the case of a 57-year-old man who had granulomatous interstitial nephritis caused by kidney parenchymal malakoplakia. Of note, using polymerase chain reaction (PCR), we were able to site-specifically amplify E coli DNA from his kidney biopsy specimens. Malakoplakia of the kidney should be considered in the differential diagnosis of granulomatous interstitial nephritis, and application of molecular biological approaches to the analysis of kidney tissues may be useful in the diagnosis of this disease.

Granulomatous Interstitial Nephritis

Granulomatous interstitial nephritis (GIN) is a rare histologic diagnosis. This series reports the presenting features, associated conditions, treatment, and outcome of patients with a diagnosis of GIN in Glasgow during a 15-yr period and compares this with the available literature. Eighteen cases were identified: Five cases were associated with sarcoidosis, two were associated with tubulointerstitial nephritis and uveitis, two were associated with medication, and nine were idiopathic. Patients presented with advanced renal failure (median estimated creatinine clearance 21 ml/min) and minimal proteinuria (urine albumin-to-creatinine ratio 9.9 mg/mmol). Sixteen patients were treated with prednisolone for a mean of 25 mo. Six patients relapsed with reduction in prednisolone dosage, and four patients required steroid-sparing agents. During the mean follow-up of 45 mo, renal function improved or stabilized in 17 patients; the rate of improvement in renal function was most marked in the first year after diagnosis with a gain in function of +1.9 ml/min per mo. The median estimated creatinine clearance at final visit was 56 ml/min. One patient required renal replacement therapy at diagnosis but recovered renal function with treatment. No patient required long-term renal replacement therapy. There was no correlation between the degree of fibrosis or inflammation on biopsy and renal outcome, and the features on biopsy did not help to determine the cause of GIN. GIN is a treatable cause of renal failure that highlights the value of renal biopsy in patients who present with renal failure even when there is minimal proteinuria. The rarity of GIN demonstrates the need for systematic data collection.