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Currently filtering by tag: Interstitial nephritis

Art of Medicine: Anti-Brush Border Antibody Disease

The above painting shows massive tubular basement membrane (electron dense on EM) deposits along proximal tubules with sparing of the distal tubules.  This is a finding that can be seen by electron microscopy in anti-brush border antibody disease (ABBA).   Tubular basement membrane deposits are also seen in lupus nephritis (all classes), IgG4-associated kidney disease, idiopathic hypocomplementemic interstitial nephritis, polyomavirus nephritis (BK virus or JC virus), or in response to certain medications (eculizumab, NSAIDS, and others).   Interstitial inflammation is not prominent in ABBA disease, as it is with other pathologies with tubular basement membrane deposits (such as IgG4-associated disease, drug reactions,...

Twitter Poll (August 7, 2019)

ANSWER: D The most common finding on kidney biopsies in patients with immune checkpoint inhibitors (ICPIs)–induced AKI is acute tubulointerstitial nephritis. Less frequently, granulomatous interstitial nephritis and TMA have also been reported. The two main ICPIs are anti-cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and anti-programmed cell death protein 1 (PD-1). The onset of kidney injury seen with PD-1 inhibitors is usually late (3-10 months) compared to CTLA-4 antagonists-related renal injury, which happens earlier (2-3 months). PD-1 inhibitors, as opposed to CTLA-4 inhibitors, have been associated with kidney rejection in transplantation. Steroids appear to be effective in treating the immune-related adverse effects...

Disease Week: Renal Manifestations of Inflammatory Bowel Disease (IBD)

Inflammatory bowel disease (IBD) is a condition characterized by chronic inflammation of the gastrointestinal tract with the two most common types Crohn disease and ulcerative colitis.  While renal and urinary involvement in IBD is not uncommon, renal parenchymal disease is rare and most commonly affects the glomerular and tubulointerstitial compartments. The most common findings on renal biopsy of IBD patients are IgA nephropathy and tubulointerstitial nephritis, and this occurrence may represent a common pathogenic mechanism. Although several cases of tubulointerstitial nephritis have been related to drug exposure, there is increasing evidence that this finding may also represent a true extraintestinal...

IgG4 Membranous

First identified in the pancreas as autoimmune pancreatitis, the IgG4-related disease is now known to affect many organs and body sites. Renal involvement may present as a discrete mass noted radiologically, or patients may present with renal failure secondary to diffuse sclerosing tubulointerstitial disease. Patients often have laboratory abnormalities that can support the diagnosis such as eosinophilia, low complement and hypergammaglobulinemia with an elevation of serum IgG4 levels. A combination of imaging, clinical and laboratory features, and histology are needed to make a definitive diagnosis. Patients often show a clinical and radiographic response to steroid therapy. The Jones methenamine silver...

Interstitial Eosinophils

Prominent interstitial eosinophils (see arrow) are most often associated with allergic-type acute interstitial nephritis (AIN).  However, eosinophils are not specific for allergic-type AIN as they may also be prominent in other acute and chronic diseases affecting the tubulointerstitium.  Diabetic patients, for example, may have prominent interstitial eosinophilic aggregates, which are usually not associated with medication use or a history of allergy (see Dai DF et al.  Interstitial eosinophilic aggregates in diabetic nephropathy: allergy or not? Nephrol Dial Transplant. 2015 Aug;30(8):1370-6).  Remember, too, that urine eosinophils can be found in a variety of upper and lower urinary tract diseases as well,...

Sjogrens

Sjögren’s syndrome is an autoimmune disease involving primarily the lacrimal and salivary glands. However, up to 27% of patients will also have renal involvement. When clinical evidence of renal involvement is present, approximately 71% show evidence of interstitial nephritis on biopsy including 46% with chronic interstitial nephritis and 25% with acute interstitial nephritis. On renal biopsy, the inflammatory infiltrates in Sjögren’s-related interstitial nephritis (as shown here) is typically mononuclear and rich in plasma cells. Unlike the interstitial nephritis was seen with IgG4-related disease or lupus, there are no tubular basement membrane deposits present by immunofluorescence.

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...

Chronic Active Tubulointerstitial Nephritis

Chronic tubulointerstitial nephritis in children may be secondary to a number of possible etiologies such as drug and other exogenous toxin exposure, infections, lower urinary tract obstruction, autoimmune diseases, nephronophthisis and genetic disorders such as autosomal dominant tubulointerstitial kidney disease due to MUC1, UMOD, REN or HNF1β. Figures 1-3 are representative images from the kidney biopsy of a 15 month old male with a history of prune belly syndrome, status post multiple lower urinary tract procedures and recurrent urinary tract infections. There is severe tubulointerstitial scarring which is disproportionate to the degree of glomerulosclerosis, with a moderate, predominantly chronic, interstitial...

Megalocytic Interstitial Nephritis

This biopsy shows a chronic active interstitial nephritis with numerous interstitial foamy macrophages containing abundant PAS-positive cytoplasmic granules (Fig 1-3).  The findings are consistent with megalocytic interstitial nephritis.  Megalocytic interstitial nephritis is an entity closely related to malakoplakia, with the absence of the characteristic Michaelis-Gutmann bodies.  This entity most frequently results from a chronic, ascending, bacterial urinary tract infection, most frequently due to E. coli or other gram-negative bacteria. 

Tubulointerstitial Nephritis with Uveitis

Tubulointerstitial nephritis with uveitis (TINU) was first described as a distinct entity by Dobrin, et al. in 1975. TINU primarily affects young females (median age 15 years) who commonly have associated systemic signs and symptoms of the disease including weight loss, fever, fatigue, malaise, abdominal or flank pain, arthralgias or myalgias, and headache. The syndrome is likely underdiagnosed as a result of the asynchronous presentation of the renal and ocular symptoms. In fact, the ocular symptoms lag behind the interstitial nephritis diagnosis in two-thirds of cases by up to 14 months. TINU should be considered a diagnosis of exclusion only...