Granulomatous Interstitial Nephritis

Abstract

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.Clin J Am Soc Nephrol 2: 222-230, 2007. doi: 10.2215/CJN.01790506 G ranulomatous interstitial nephritis (GIN) is a rare histologic diagnosis that is present in between 0.5 and 0.9% of native renal biopsies (1,2) and 0.6% of renal transplant biopsies (3). GIN has been associated with medication, infections, sarcoidosis, crystal deposits, paraproteinemia, and Wegener's granulomatosis and also is seen in an idiopathic form. Medicines implicated include anticonvulsants, antibiotics, nonsteroidal anti-inflammatory drugs, allopurinol, and diuretics. Mycobacteria and fungi are the main infective causes and seem to be the main causative factor in cases in renal transplants (3,4). Few studies have analyzed the natural history and treatment of GIN; the largest included only seven patients (5). The purpose of this study was to analyze clinical features and outcome of patients who had GIN and presented in Glasgow between 1990 and 2004 and to compare our data with the four largest published series (1,5-7). Materials and MethodsPatients with a diagnosis of GIN were identified by a search of electronic patient records of all patients who have attended Glasgow renal units and associated satellite clinics since 1990. Hemoglobin, serum creatinine, serum calcium concentrations, peripheral blood eosinophil count, and quantified proteinuria at diagno...

Renal failure due to granulomatous interstitial nephritis in native and allograft renal biopsies: experience from a tertiary care hospital

“…10 Our study is in agreement with the prior study from India. Majority of the patients in our series presented with advanced renal failure with minimal proteinuria as described in the study by Joss et al 11 Chapagain et al 12 have described 25 cases of tuberculous tubulointerstitial nephritis of which 17 patients had biopsy proven granulomatous interstitial nephritis. Majority of the patients in this series were of Indian origin.…”

Non-Caseating Granulamatus Nephritis: Rare Sign of Sarcoidosis

“…Renal yetmezlik yaygın değildir (3,(6)(7)(8)(9). Sarkoidoz ilişkili intertisyel nefrit genellikle sarkoidozun başlangıcında görülür ve uzun süre sarkoidoz tanısı alan hastalarda nadir görülür.…”

Granulomatous interstitial nephritis causing renal failure, a rare presentation of childhood sarcoidosis

“…GIN is a distinct renal pathology but is not pathognomic of sarcoidosis.It is an uncommon histological diagnosis. A large retrospective study of native kidney biopsies found GIN in <1% of patients over a 15-year period 7 . GIN may be seen with mycobacterial and fungal infections, Wegener's Granulomatosis and drugs 8 .…”