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Currently filtering by tag: Granulomatous interstitial nephritis

Granulomatous Interstitial Nephritis in CLL

This is a renal biopsy from a 62-year-old female with a recent diagnosis of CLL/SLL, who presents with rapidly worsening renal function. The serum creatinine is 4.7 mg/dl (2.7 mg/dl 3 months prior). The biopsy shows a dense multifocal infiltrate of monomorphic small lymphocytes (Fig 1) which stain strongly positive for CD20 (Fig 4) and CD5 (not shown), and negative for CD3 (Fig 3). The background renal parenchyma shows moderate, mixed inflammation with scattered CD3 positive cells. Additionally, the interstitium multifocally shows granulomatous inflammation with giant cells (Fig 2). These findings are consistent with renal involvement by the patient’s know...

Tuberculosis – AFB and Rhodamine

A 69-year-old Caucasian man presented with general malaise and multiple febrile episodes that started several weeks prior to presentation. He was found to have a serum Cr of 3.6 mg/dl. Urinalysis showed 20 to 30 red blood cells/high-power field and occasional white blood cells. Urine showed a protein: Cr ratio of 2. A biopsy was performed to evaluate the etiology of the renal failure. Photomicrographs A and B show caseating necrosis in the renal parenchyma. Rare acid-fast bacilli were identified on the auramine-rhodamine (C) and acid-fast (D) stains. Follow-up laboratories confirmed the presence of a mycobacterium tuberculosis infection. Tuberculosis may...

Granulomatous Interstitial Nephritis Differential

This biopsy is from a 25-year-old African American female with renal failure. The photomicrographs here show renal involvement by non-caseating granulomas eliciting the diagnosis of granulomatous interstitial nephritis. The patient was found to be hypercalcemic and to have hilar lymphadenopathy and reticulonodular infiltrates on chest x-ray and was diagnosed with sarcoidosis. A case series examining 46 cases of granulomatous interstitial nephritis (GIN) by Bijol et al (ref below) found the most common etiology (45%) of this pattern to be a drug-induced reaction. This was followed by sarcoidosis (29% of GIN), other (including infection) at 16% and there were 10% of...

Pushing Glass (September 20, 2017)

The patient is a 65-year-old African American female who presents with a protein/creatinine ratio of 2 and a serum creatinine of 3.5 mg/dl. Serologies for ANA, dsDNA, c-ANCA, p-ANCA, and rheumatoid factor are negative. On CT examination, she has several enlarged peribronchial lymph nodes. Her ACE level is elevated. What is the best diagnosis? A. Necrotizing Vasculitis. B. Acute Interstitial Nephritis Concerning for a Drug Reaction. C. Granulomatous Interstitial Nephritis Concerning for Sarcoidosis. D. ANCA-associated Vasculitis with Diffuse Crescents. The correct answer is c: Granulomatous Interstitial Nephritis Concerning for Sarcoidosis. The biopsy shows a florid example of non-caseating granulomas throughout...

Granulomatous Interstitial Nephritis

The photomicrograph shows an interstitial granuloma from a case of granulomatous interstitial nephritis. The presence of granulomas within interstitial nephritis frequently raises the differential diagnosis of unusual infections such as fungal and mycobacterial. However, a case series conducted within the United States showed that drug-induced reactions are the etiology of 45% of granulomatous interstitial nephritis cases followed by sarcoidosis in another 30%. The remaining 25% included 10% of cases that were idiopathic and 15% due to a variety of other etiologies such as systemic vasculitis, foreign body giant cell reaction, and infection. Reference: Bijol V, et al. Int J Surg...