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Interstitial nephritis [keywords]
- Mathematical model of renal interstitial fibrosis. [JOURNAL ARTICLE]
- Proc Natl Acad Sci U S A 2014 Sep 15.
Lupus nephritis (LN) is an autoimmune disease that occurs when autoantibodies complex with self-antigen and form immune complexes that accumulate in the glomeruli. These immune complexes initiate an inflammatory response resulting in glomerular injury. LN often concomitantly affects the tubulointerstitial compartment of the kidney, leading first to interstitial inflammation and subsequently to interstitial fibrosis and atrophy of the renal tubules if not appropriately treated. Presently the only way to assess interstitial inflammation and fibrosis is through kidney biopsy, which is invasive and cannot be repeated frequently. Hence, monitoring of disease progression and response to therapy is suboptimal. In this paper we describe a mathematical model of the progress from tubulointerstitial inflammation to fibrosis. We demonstrate how the model can be used to monitor treatments for interstitial fibrosis in LN with drugs currently being developed or used for nonrenal fibrosis.
- [Prospective study of drug-induced allergic nephropathy in eleven French nephrology units.] [JOURNAL ARTICLE]
- Presse Med 2014 Sep 10.
Certain medications have been associated with drug-induced acute interstitial nephritis (AIN), but few prospective studies have been published. This prospective observational study aims to record and assess incidents of drug-induced AIN observed over a period of one year in nephrology units in France. The goal is to determine which medications are involved in AIN and to expound the clinical and biological presentation, management, and evolution of AIN.Between April 2012 and April 2013, drug-associated cases of AIN were prospectively recorded in 24 patients registered in 11 nephrology units that belong to the Société de Néphrologie de l'Ouest (SNO). Data sheets, including suspected and concomitant drug(s), kidney function assessment, biological disturbances, clinical signs, histological data, management, and evolution, were collected by the Rennes Regional Pharmacovigilance Center and recorded in the French pharmacovigilance database.In order, the most frequently involved medications in the AIN cases were: vitamin K antagonists (33.3% of the cases, almost exclusively fluindione), antibiotics (20.8% of cases) non-steroidal anti-inflammatory drugs (20.8% of cases), and proton pump inhibitors (16.7% of cases). The mean delay of onset to AIN was 8.3 weeks. At the time of diagnosis, mean serum creatinine was 366μM, higher for vitamin K antagonists (VKAs), except in the case of warfarin. During the course of an AIN event, 70% of patients had complete blood count and/or urine analysis abnormalities, 55% had clinical signs of systemic hypersensitivity, and 13% of patients had hepatic disorders. Renal biopsies were performed in 54% of patients; however, only 37% of patients requiring therapeutic anticoagulation underwent a biopsy. Suspected drugs were discontinued in all patients and the majority was treated with oral corticosteroids. Renal function often continued to be impaired after an AIN event. At baseline, 25% of patients had chronic kidney disease (CKD); after an AIN event, 67% of patients were noted to have CKD.Physicians need to be aware of the possibility of drug-induced acute interstitial nephritis as a common cause of acute kidney injury (AKI). This study supports increased vigilance when prescribing three therapeutic classes frequently associated with AIN: antibiotics, NSAIDs and PPIs (especially in instances of polypharmacy), which were associated with two thirds of the AIN cases in this study. Fluindione, an oral anticoagulant exclusively marketed in Luxembourg and France where it constitutes the vast majority of VKA prescriptions, was associated with one third of the AIN cases alone, making it a common possible culprit of drug-induced AIN, warranting particular attention.
- Analysis of TMEM174 gene expression in various renal cancer types by RNA in situ hybridization. [JOURNAL ARTICLE]
- Oncol Lett 2014 Oct; 8(4):1693-1696.
Transmembrane protein 174 (TMEM174) mRNA is easily detectable in human kidney tissues and activates AP-1 and promotes 293T cell proliferation. In the present study, RNA in situ hybridization was used to detect TMEM174 gene expression in various malignant renal cancer and normal renal tissues. The results showed that TMEM174 exhibits differential expression in renal tissues, with a high positive rate of expression in squamous cell carcinoma with necrosis, papillary renal cell carcinoma and transitional cell carcinoma, and a low positive rate of expression in clear cell carcinoma, interstitial nephritis, undifferentiated carcinoma, retroperitoneal metastatic clear cell carcinoma, adrenal gland metastatic clear cell carcinoma, pelvic cavity metastatic chromophobe carcinoma, severe atypical hyperplasia of transitional epithelium and hyperplasia. Extremely weak expression was exhibited in collecting duct carcinoma, Wilms' tumor, chronic pyelonephritis, acute pyelonephritis, cancer adjacent normal renal tissue and normal renal tissue. In conclusion, the TMEM174 gene exhibited high expression levels in certain renal carcinomas, which may indicate that TMEM174 may have a significant role in the development and progression of these renal carcinomas.
- Osteomalacia complicating renal tubular acidosis in association with Sjogren's syndrome. [JOURNAL ARTICLE]
- Saudi J Kidney Dis Transpl 2014 September-October; 25(5):1072-1077.
Renal involvement in Sjogren's syndrome (SS) is not uncommon and may precede other complaints. Tubulointerstitial nephritis is the most common renal disease in SS and may lead to renal tubular acidosis (RTA), which in turn may cause osteomalacia. Nevertheless, osteomalacia rarely occurs as the first manifestation of a renal tubule disorder due to SS. We herewith describe a 43-year-old woman who was admitted to our hospital for weakness, lumbago and inability to walk. X-ray of the long bones showed extensive demineralization of the bones. Laboratory investigations revealed chronic kidney disease with serum creatinine of 2.3 mg/dL and creatinine clearance of 40 mL/min, hypokalemia (3.2 mmol/L), hypophosphatemia (0.4 mmol/L), hypocalcemia (2.14 mmol/L) and hyperchloremic metabolic acidosis (chlorine: 114 mmol/L; alkaline reserve: 14 mmol/L). The serum alkaline phosphatase levels were elevated. The serum levels of 25-hydroxyvitamin D and 1,25-dihydroxy vitamin D were low and borderline low, respectively, and the parathyroid hormone level was 70 pg/L. Urinalysis showed inappropriate alkaline urine (urinary PH: 7), glycosuria with normal blood glucose, phosphaturia and uricosuria. These values indicated the presence of both distal and proximal RTA. Our patient reported dryness of the mouth and eyes and Schirmer's test showed xerophthalmia. An accessory salivary gland biopsy showed changes corresponding to stage IV of Chisholm and Masson score. Kidney biopsy showed diffuse and severe tubulo-interstitial nephritis with dense lymphoplasmocyte infiltrates. Sicca syndrome and renal interstitial infiltrates indicated SS as the underlying cause of the RTA and osteomalacia. The patient received alkalinization, vitamin D (Sterogyl ®), calcium supplements and steroids in an initial dose of 1 mg/kg/day, tapered to 10 mg daily. The prognosis was favorable and the serum creatinine level was 1.7 mg/dL, calcium was 2.2 mmol/L and serum phosphate was 0.9 mmol/L.
- Allergic Interstitial Nephritis Due to Ceftaroline. [JOURNAL ARTICLE]
- Am J Med Sci 2014 Sep 4.
- Infectious Diseases and Tropical Disease Pathology: SY16-2A PATHOLOGY OF LEPTOSPIROSIS: AUTOPSY STUDY. [Journal Article]
- Pathology 2014 Oct.:S27.
Autopsy studies were performed on 4 cases who had clinical and epidemiological data suggestive of leptospirosis complicated with multiorgan involvement. The diagnosis of leptospirosis was confirmed by strongly positive microscopic agglutination test. The immunoblotting data revealed antibodies against more than one serovar of leptospires. All patients were males who presented with fever, myalgia, hypotension, breathlessness, oliguria and one out of 4 had also icterus. All 4 cases died one to four days after admission. Pancarditis, arteritis of coronary arteries, intra-alveolar hemorrhage of both lungs, acute interstitial nephritis with focal tubular necrosis and occasional acute proliferative glomerulonephritis were present in every case. Two cases showed also acute meningitis and choroid plexitis. Acute hemorrhagic splenitis with severe lymphoid depletion and triaditis of portal tracts of the liver with focal acute hemorrhagic pancreatitis were also seen in one case.
- Acute interstitial nephritis induced by Dioscorea quinqueloba. [JOURNAL ARTICLE]
- BMC Nephrol 2014 Sep 3; 15(1):143.
The use of herbal medicine may be a risk factor for the development of kidney injury, as it has been reported to cause various renal syndromes. Dioscorea quinqueloba is a medicinal herb that is used as an alternative therapy for cardiovascular disease and various medical conditions.A 52-year-old man was admitted with complaints of skin rash and burning sensation. He had ingested a raw extract of D. quinqueloba as a traditional remedy. Laboratory tests revealed the following values: absolute eosinophil count, 900/mm3; serum creatinine level, 2.7 mg/dL; and blood urea nitrogen, 33.0 mg/dL. The immunoglobulin E level was markedly increased at 1320.0 IU/mL. Urinalysis revealed a fractional excretion of sodium of 3.77%, protein 1+, and blood 3+. Histological examination of the renal biopsy specimen showed a diffusely edematous interstitium with infiltrates composed of eosinophils, lymphocytes, and neutrophils.Here, we present the first reported case of biopsy-proven acute interstitial nephritis following ingestion of D. quinqueloba associated with skin rash, eosinophilia, and increased plasma immunoglobulin E level.
- Clinical characteristics, causes and outcomes of acute interstitial nephritis in the elderly. [JOURNAL ARTICLE]
- Kidney Int 2014 Sep 3.
Acute interstitial nephritis (AIN) is an important cause of acute kidney injury (AKI), and its prevalence in the elderly may be increasing. It is largely unknown whether AIN in the elderly is similar to that in younger adults; therefore, we investigated the causes and characteristics of AIN in 45 elderly patients (65 years and older) and in 88 younger adults (18-64 years old). Compared with younger patients, the elderly had significantly more drug-induced AIN (87 vs. 64%), proton pump inhibitor-induced AIN (18 vs. 6%), but significantly less AIN due to autoimmune or systemic causes (7 vs. 27%). The two most common culprit drugs in the elderly were penicillin and omeprazole. Compared with younger patients, the elderly had higher prevalence of baseline CKD, higher peak creatinine, and more need for dialysis, all of which were significant. Among the elderly, 86% showed partial or complete recovery within 6 months. Significantly shorter delays in initiation of steroids correlated with recovery at 6 months. Lack of early recovery tended to correlate with progressive CKD. Compared with antibiotic-induced AIN, proton pump inhibitor-induced AIN had less severe AKI, but a longer duration of drug exposure, and was less likely to recover by 6 months, all significant. Thus, the vast majority of AIN cases in the elderly are due to drugs, primarily owing to proton pump inhibitors and antibiotics, while AIN of autoimmune or systemic origin is uncommon.Kidney International advance online publication, 3 September 2014; doi:10.1038/ki.2014.294.
- Ocular and Systemic Morbidity in a Longitudinal Cohort of Sjögren's Syndrome. [JOURNAL ARTICLE]
- Ophthalmology 2014 Aug 29.
To report vision-threatening ocular manifestations of primary Sjögren's syndrome (SS).Retrospective review.Consecutive patients evaluated at an SS center between January 2007 and May 2011.Data collection was completed in March 2013. The 2002 American-European consensus criteria were used for diagnosis of SS.Frequency of extraglandular ocular findings and timing of their diagnosis relative to that of SS and dry eye were assessed.One hundred sixty-three patients were included. Almost all patients (98%) had a history of dry eye for an average of 10.4 years (median, 7.9 years) before presentation. One or more extraglandular ocular manifestations were present in 40 patients (25%), and vision-threatening findings were present in 22 patients (13%). Twelve patients (55%) with a vision-threatening ocular finding did not have a diagnosis of SS at presentation. Sixty-eight patients (42%) had extraglandular systemic manifestations of SS. Patients with vision-threatening ocular findings were 3.9 times more likely to have systemic involvement (95% confidence interval, 1.4-11.0; P = 0.010). Peripheral neuropathy, interstitial nephritis, and vasculitis were more common in those with vision-threatening ocular findings compared with patients without (P < 0.05 for all).These results from a tertiary referral-based cohort demonstrate that primary SS frequently is associated with ocular and systemic complications. Dry eye precedes these findings on average by 1 decade. Therefore, ophthalmologists should consider assessing for SS in patients with clinically significant dry eye.
- Renal failure due to granulomatous interstitial nephritis in native and allograft renal biopsies: experience from a tertiary care hospital. [JOURNAL ARTICLE]
- Ren Fail 2014 Aug 26.:1-3.
Abstract Granulomatous interstitial nephritis is a rare cause of renal failure in both native and allograft renal biopsies. Drugs and sarcoidosis are the commonest causes of granulomatous interstitial nephritis as reported in Western countries. Unlike the west, tuberculosis is the commonest cause of granulomatous interstitial nephritis in Indian subcontinent. The etiological factors, clinical course, glomerular and tubulointerstitial changes associated with granulomatous interstitial nephritis have been analyzed in the present study along with the outcome in patients with granulomatous interstitial nephritis.