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Interstitial nephritis [keywords]
- The Histopathologic Spectrum of Kidney Biopsies in Patients with Inflammatory Bowel Disease. [JOURNAL ARTICLE]
- Clin J Am Soc Nephrol 2013 Nov 21.
Kidney disease as a complication of inflammatory bowel disease (IBD), including Crohn disease (CD) and ulcerative colitis (UC), has been the subject of case reports. However, no cases series examining IBD and kidney disease has been published to date. This study aimed to evaluate a large series of kidney biopsy specimens from patients with IBD to better define the spectrum and relative frequencies of IBD-associated kidney pathology.A retrospective review of native kidney biopsy specimens obtained from March 2001 to June 2012 identified 83 patients with IBD. Standard processing of all biopsy specimens included light microscopy, immunofluorescence, and electron microscopy.There were 45 cases of CD and 38 cases of UC represented. The most common indication for kidney biopsy was acute or chronic kidney failure (63% [52 of 83]) and nephrotic-range proteinuria (16% [13 of 83]). IgA nephropathy was the most common diagnosis (24% [20 of 83]), followed by interstitial nephritis (19% [16 of 83]), arterionephrosclerosis (12% [10 of 83]), acute tubular injury (8% [7 of 83]), proliferative GN (7% [6 of 83]), and minimal-change disease (5% [4 of 83]). When compared, the frequency of IgA nephropathy in IBD was significantly higher than in all other native renal biopsy specimens from the same time period (24% [20 of 83] versus 8% [2734 of 33,630]; P<0.001). Of the 16 cases of interstitial nephritis, 9 (56%) had current or recent past exposure to aminosalicylates, including all cases of granulomatous interstitial nephritis.IBD is associated with a spectrum of kidney diseases most commonly affecting the glomerular and tubulointerstitial compartments. IgA nephropathy is the most frequent kidney biopsy diagnosis in IBD and has a significantly higher diagnostic prevalence compared with all non-IBD kidney biopsy specimens. This may reflect a common pathogenic mechanism. Although many cases of tubulointerstitial nephritis are related to aminosalicylate exposure, the possibility of a direct relationship with IBD cannot be ruled out.
- Risks of inflammatory bowel disease treatment with glucocorticosteroids and aminosalicylates. [Journal Article]
- Dig Dis 2013; 31(3-4):368-73.
Background:Glucocorticosteroids and aminosalicylates, mainly mesalazine (5-ASA), are both standard therapeutics in the treatment of inflammatory bowel disease (IBD) patients. The glucocorticosteroids are highly effective in inducing remission in both ulcerative colitis and Crohn's disease, but their use is limited by the high incidence and the potentially serious nature of adverse events. In an attempt to limit systemic side effects, rapidly metabolized corticosteroids such as budesonide have been introduced. The safety profile of aminosalicylates differs between the formulations.
Methods:We summarize the potential risks associated with glucocorticosteroid and aminosalicylate therapy in IBDs.
Results:The numerous adverse events of glucocorticosteroids, particularly at high doses and prolonged treatment, include opportunistic infections, diabetes mellitus, hypertension, ocular effects (glaucoma and cataracts), psychiatric complications, hypothalamic-pituitary-adrenal axis suppression and increased fracture risk. Partially, these systemic adverse events occur with budesonide, which only has a low systemic exposure. The safety profile of 5-ASA is comparable to placebo and superior to the old aminosalicylate prodrug sulfasalazine, which had a significantly higher incidence of intolerance reactions including allergic rashes. Only in rare cases has nephrotoxicity such as interstitial nephritis been associated with 5-ASA.
Conclusion:Considering the toxicity profile of conventional glucocorticosteroids, one primary goal of treatment in IBD should be corticosteroid-free remission. Therapy with budesonide may result in a better safety profile. 5-ASA treatment is usually well tolerated, but with regard to the rare nephrotoxic events, it is advisable to assess renal function before and during treatment with 5-ASA. © 2013 S. Karger AG, Basel.
- Levetiracetam following liver and kidney failure in late-onset anticonvulsant hypersensitivity syndrome. [JOURNAL ARTICLE]
- J Clin Neurosci 2013 Sep 4.
Anticonvulsant hypersensitivity syndrome is an adverse drug reaction usually occurring from 1 to 8weeks after exposure to antiepileptic drugs. It can threaten life by affecting the liver, kidneys, central nervous system or lungs. We present a 47-year-old patient treated with phenytoin, lamotrigine and clobazam for 7years. He presented with hepatic and renal failure in relation to this syndrome demonstrated by renal biopsy. Prognosis was excellent due to an early diagnosis leading to cessation of the causative agents. Levetiracetam was started with a good response.
- Treatment of renal sarcoidosis: is there a guideline? Overview of the different treatment options. [JOURNAL ARTICLE]
- Nephrol Dial Transplant 2013 Nov 13.
Sarcoidosis is a multisystem granulomatous disease of unknown aetiology characterized by the presence of noncaseating granulomas. It may affect any organ including the kidney. A disordered calcium metabolism is most often responsible for the development of renal failure. Granulomatous interstitial nephritis is the most typical histological finding, but it rarely leads to renal insufficiency. Since development of renal insufficiency in sarcoidosis is uncommon, we lack large (randomized) trials concerning the treatment of this disorder. We gather most information from case reports and small series. Our knowledge of pulmonary sarcoidosis is more comprehensive. It is, however, impossible to treat renal manifestations identically because some of the drugs used in pulmonary sarcoidosis are nephrotoxic. Moreover, renal sarcoidosis is a specific entity with its own characteristics and response to therapy. A guideline for treatment is currently missing. Based on a review of the literature, we present an overview of the different treatment options to promote a more uniform and scrutinized approach of this disease. Hypercalcaemia and hypercalciuria can be treated with corticosteroids, (hydroxy)chloroquine or ketoconazole. Preventive measures play a supportive role. In granulomatous interstitial nephritis, glucocorticoids are the standard of care. In patients with failure of or a contraindication to corticosteroids or in those patients who need a high maintenance dose of corticosteroids, azathioprine or mycophenolate mofetil can be used. TNF-alpha inhibitors are useful in case of steroid-resistant sarcoidosis or in patients who develop severe steroid toxicity. With increasing insight in the pathogenesis of sarcoidosis, other immunosuppressive drugs have been proposed, but more research is necessary before their routine use can be advocated.
- Antiphospholipid syndrome nephropathy (APSN) in patients with lupus nephritis: a retrospective clinical and renal pathology study. [JOURNAL ARTICLE]
- Rheumatol Int 2013 Nov 15.
Data about clinical-laboratory features and outcome of antiphospholipid syndrome nephropathy (APSN) in the course of lupus nephritis (LN) are scarce. To determine prevalence, clinical correlations and outcome of APSN in patients with LN, retrospective analysis of renal specimens and review of medical records from 48 LN patients were performed. APSN was found in 12/48 (25 %) of LN. Positivity for lupus anticoagulant (LAC) and double antiphospholipids positivity [LAC plus anticardiolipin (aCL)] were significantly more frequent in APSN-LN (p = 0.02 and p = 0.01, respectively) than in LN, while single aCL positivity was not. Overt antiphospholipid syndrome appeared more frequent in patients with APSN-LN (p = 0.05). There were no statistically significant differences between APSN-LN and LN in the proportion of each World Health Organization class of LN (with the exception of a trend toward fewer Class III LN in APS-LN) and in the systemic lupus erythematosus (SLE) disease duration and severity. At the time of renal biopsy, patients with APSN-LN had median serum creatinine levels significantly higher than patients with LN [1.45 (0.6-6.6) vs. 1.00 (0.7-3.0), p = 0.02]. Double antiphospholipid positivity was the only variable significantly associated with APSN-LN at multivariate regression analysis (OR 8, 95 % CI 1.7-37, p = 0,008). APSN-LN and LN did not differ significantly as regards the rate of complete (25 vs. 19.4 %, p = 0.72) and partial treatment response (25 vs. 29 %, p = 0.82) at 6 months and the progression to end-stage renal disease after a median follow-up of 8.1 ± 3.6 years (16.6 vs. 13.8 %, p = 0.82). APSN was demonstrated in a quart of LN, appeared to be independent from underlying LN class and SLE severity, and did not seem to confer a worse prognosis to LN. The findings of higher creatinine and more interstitial fibrosis in APSN should be confirmed in future prospective larger studies.
- Varenicline induced acute interstitial nephritis in the setting of idiopathic membranous glomerulonephritis. [JOURNAL ARTICLE]
- BMC Nephrol 2013 Nov 11; 14(1):248.
Varenicline is a nicotinic receptor partial agonist indicated for the cessation of smoking. It is regarded as having no or minimal renal toxicity. A single case report has linked it to acute interstitial nephritis.A 56 year-old female with a long-standing history of idiopathic membranous glomerulonephritis presented on routine follow-up with an unexpected rise in her serum creatinine from a stable baseline of 225 umol/L to 319 umol/L Biopsy revealed acute interstitial nephritis. There were no preceding clinical events other than the initiation of varenicline therapy three months prior. This was discontinued with no improvement in renal function. A ten week course of prednisone was initiated and creatinine levels returned to baseline. Shortly after prednisone therapy was completed, renal function worsened but the patient declined further immunosuppressive therapy. Exposure to varenicline therapy two years prior had also resulted in a reversible decline in kidney function.This is only the second case report to document varenicline-induced acute interstitial nephritis. A careful medication history and renal biopsy were essential in identifying the etiology of the acute kidney injury in this patient with a complex renal history.
- [Gougerot-Sjögren syndrome complicated by pulmonary aspergilloma]. [Journal Article]
- Pan Afr Med J 2013.:71.
- [A patient with recurrent ovarian clear cell adenocarcinoma and chronic kidney disease exhibited complete response to paclitaxel plus carboplatin]. [English Abstract, Journal Article]
- Gan To Kagaku Ryoho 2013 Oct; 40(10):1419-21.
A 41-year-old woman receiving hemodialysis 3 times a week for chronic kidney disease caused by interstitial nephritis was referred to our hospital because of a pelvic mass and subsequently underwent primary surgery. The patient was diagnosed with FIGO stage Ic (b) clear cell adenocarcinoma. She did not receive postoperative chemotherapy. However, 9 months after surgery, ascites and a pelvic mass developed, on the basis of which recurrence was confirmed. She received combination chemotherapy with paclitaxel plus carboplatin (TC). Paclitaxel was administered at 175 mg/m2, and the carboplatin dosage was calculated by the Calvert formula. The glomerular filtration rate was considered to be 0, and the target area under the plasma concentration versus time curve was 5. Hemodialysis was performed 24 hours after the infusion of carboplatin. After 6 courses of combination chemotherapy, complete response was confirmed by computed tomography. The patient developed grade 3 neutropenia, grade 1 sensory neuropathy , and grade 2 alopecia, but the other adverse events were mild. In conclusion, TC combination chemotherapy was well tolerated and generated a good response in a patient with recurrent ovarian clear cell adenocarcinoma who was receiving hemodialysis for chronic kidney disease.
- Acute focal bacterial nephritis developed in a healthy child. [Journal Article]
- Turk J Pediatr 2013 Mar-Apr; 55(2):226-8.
Acute focal bacterial nephritis (AFBN) is a rare cause of interstitial bacterial nephritis. Ultrasound identifies AFBN as a hypoechogenic and hypoperfused parenchymal lesion, which requires its differentiation from renal abscess and tumor. Hematogenous spread or ascending infection arising from the lower urinary tract is thought to be involved in the pathogenesis of AFBN. Herein, a six-year-old healthy male patient, diagnosed using ultrasound and computerized tomography (CT) and treated with intravenous antibiotics, is presented. As a result, AFBN can be seen in healthy children without any history of reflux or urinary tract infection, and differentiation from renal abscess is important.
- Rosuvastatin-induced acute interstitial nephritis. [Journal Article]
- Case Rep Nephrol Urol 2013; 3(1):87-90.
We report a case of acute interstitial nephritis (AIN), most likely induced by rosuvastatin, in an 83-year-old male patient. The patient underwent angioplasty of the left internal carotid artery, after which he began a regimen of rosuvastatin (20 mg/day). After 3 weeks the patient was admitted to our unit for acute renal failure with mild proteinuria with negligible urinary sediment. A left kidney biopsy showed dense interstitial infiltrates, mainly composed of lymphocytes with evident tubulitis. Rosuvastatin withdrawal plus prednisolone (1 mg/kg/day) treatment, which was slowly tapered over a period of 4 weeks, allowed for a complete recovery of renal function. To our knowledge, this is the first case report of rosuvastatin-induced AIN. Acute renal failure is associated with a clear increase in morbidity, length of hospital stay and mortality. Moreover, since statins are among the most widely prescribed drugs in Western countries, we think that the risk of AIN should be taken into account as a possible side effect of rosuvastatin.