Granulomatous Interstitial Nephritis and Uveitis Presenting as Salt-Losing Nephropathy

Nzerue, Chike; Schlanger, Lynn E.; Jena, Madhumita; Hewan-Lowe, Karlene

doi:10.1159/000169142

Cited by 11 publications

(4 citation statements)

References 13 publications

(14 reference statements)

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“…TINU may be difficult to be differentiated from sarcoidosis because it is not unusual for sarcoid patients to present with uveitis and interstitial kidney diseases. Moreover, in many reported cases of TINU, the kidneys [18][19][20], liver [21], and bone marrow [19,22,23] have demonstrated sarcoid-like noncaseating granulomas. In these cases, the diagnosis of TINU was favored over that of sarcoidosis due to the absence of pulmonary involvement or increased angiotensin-converting enzyme inhibitor activity or increased urinary beta-2 microglobulin (B2M).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Acute Kidney Injury Relevant to Tubulointerstitial Nephritis with Late-Onset Uveitis Superimposed by Thrombotic Microangiopathy: A Case Report and Review of the Literature

Zhao

Yang

et al. 2020

Kidney Dis

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Background: The syndrome of tubulointerstitial nephritis and uveitis (TINU) is an uncommon and multisystemic autoimmune disorder. This review reports a rare case of TINU being superimposed on thrombotic microangiopathy (TMA) and, by comparing with the available literature, also summarizes the clinical features, associated conditions, treatment, and outcome of patients with TINU. Summary: Herein, we report the case of a 37-year-old male patient with acute kidney injury (AKI) clinicopathologically identified as malignant hypertension-induced TMA superimposed by acute tubulointerstitial nephritis, which was suspected to be related to drug hypersensitivity. After treatment with oral prednisone combined with a renin-angiotensin system inhibitor, the patient achieved partial renal recovery and was withdrawn from hemodialysis. Recurrent AKI concomitant with new-onset asymptomatic uveitis was detected during routine clinical follow-up after cessation of prednisone. TINU was then diagnosed, and prednisone followed by cyclophosphamide was prescribed. The patient achieved better renal recovery than in the first round of treatment and maintained stable renal function afterward. By reviewing the literature, 36 cases were reported as TINU superimposed on other conditions, including thyroiditis, osteoarthropathy, and sarcoid-like noncaseating granulomas. Key messages: TINU could be complicated by many other conditions, among which TMA is very rare. When presented as AKI, kidney biopsy is important for differential diagnosis. The case also shows that recurrent AKI with concomitant uveitis after prednisone withdrawal strongly suggested the need for long-term follow-up and elongated prednisone therapy for TINU syndrome.

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Section: Discussionmentioning

confidence: 99%

“…Evidence of tubular dysfunction is abundant in case reports. Fanconi complex [24][25][26][27][28][29][30], nephrogenic diabetes insipidus [19], and Sjogren's syndrome [31] featuring as distal renal tubular acidosis have been present. Environmental exposures may play a role.…”

Section: Discussionmentioning

confidence: 99%

Acute Kidney Injury Relevant to Tubulointerstitial Nephritis with Late-Onset Uveitis Superimposed by Thrombotic Microangiopathy: A Case Report and Review of the Literature

Zhao

Yang

et al. 2020

Kidney Dis

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“…TINU syndrome is also called Dobrin syndrome because Dobrin described it for the first time in 1975. TINU syndrome is considered a distinct entity from S because of the absence of hypercalcemia, hypercalciuria and bihilar lymphadenopathy [63]. These patients should be evaluated for Sjőrgren's syndrome [64].…”

Section: Tubulointerstitial Nephritis and Uveitis Syndromementioning

confidence: 99%

Renal Sarcoidosis: One Disease, Different Kidney Involvements

Rastelli,

Benozzi,

Cusinato

2023

Sarcoidosis - Diagnosis, Research, and Therapy of a Granulomatous Disease

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Renal sarcoidosis has a low frequency, from 0.1% to 0.2%, considering American monocentric cohorts of about 10,000 native kidney biopsies performed in 10-year period. Acute kidney injury (AKI), occurring in <1% of patients, brings sarcoidosis to nephrologist’s attention. AKI in sarcoidosis is mainly due to hypercalcemia and sarcoid granulomatous interstitial nephritis (sGIN), the hallmark pathological finding of the disease. AKI related to hypercalcemia generally responds to steroids. At the contrary, not always all sGIN-AKI has a benign prognosis. This chapter will describe the widest casistics of renal sarcoidosis, considering the predictive value of clinical features, laboratory, radiological parameters, and histological patterns regarding induction therapy response to AKI. Rarely sarcoidosis is life-threatening: fatal events could occur during AKI or during the progression from chronic kidney disease (CKD) to end-stage renal disease (ESRD), a high-risk condition for cardiovascular, infectious, and oncological events. AKI to CKD transition due to specific injury of renal sarcoidosis is one of the most interesting aspects for nephrologists, as the reason why only a minority of sGIN cases will develop AKI: generally, sGIN is s a silent finding observed at autopsy in 7–23% of sarcoidosis patients.

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“…One patient presented with simultaneous renal failure and uveitis and the other developed uveitis following a diagnosis of idiopathic GIN. Granulomatous TINU has also been associated with a salt wasting nephropathy [ 63 ]. Treatment with corticosteroids generally leads to an improvement in creatinine clearance [ 13 , 14 , 57 , 59 , 63 ].…”

Section: Common Causes Of Ginmentioning

confidence: 99%

Granulomatous interstitial nephritis

2015

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Granulomatous interstitial nephritis (GIN) is a rare entity detected in ∼0.5–0.9% of all renal biopsies. GIN has been linked to several antibiotics such as cephalosporins, vancomycin, nitrofurantoin and ciprofloxacin. It is also associated with NSAIDs and granulomatous disorders such as sarcoidosis, tuberculosis, fungal infections, and granulomatosis with polyangiitis. Renal biopsy is critical in establishing this diagnosis, and the extent of tubular atrophy and interstitial fibrosis may aid in determining prognosis. Retrospective data and clinical experience suggest that removal of the offending agent in conjunction with corticosteroid therapy often results in improvement in renal function. We describe a patient with a history of multiple spinal surgeries complicated by wound infection who presented with confusion and rash with subsequent development of acute kidney injury. Urinalysis demonstrated pyuria and eosinophiluria, and renal biopsy revealed acute interstitial nephritis with granulomas. These findings were attributed to doxycycline treatment of his wound infection. This review explores the clinical associations, presentation, diagnosis, and treatment of this uncommon cause of acute kidney injury.

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Granulomatous Interstitial Nephritis and Uveitis Presenting as Salt-Losing Nephropathy

Cited by 11 publications

References 13 publications

Acute Kidney Injury Relevant to Tubulointerstitial Nephritis with Late-Onset Uveitis Superimposed by Thrombotic Microangiopathy: A Case Report and Review of the Literature

Acute Kidney Injury Relevant to Tubulointerstitial Nephritis with Late-Onset Uveitis Superimposed by Thrombotic Microangiopathy: A Case Report and Review of the Literature

Renal Sarcoidosis: One Disease, Different Kidney Involvements

Granulomatous interstitial nephritis

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