Granulomatous interstitial nephritis in a renal allograft

Abstract

We describe a middle-aged woman in whom granulomatous interstitial nephritis (GIN) developed in a renal allograft. She had undergone bowel resection due to an uncertain diagnosis of active granulomatous bowel disease 30 years earlier. Thereafter, frequent hyperoxaluria as well as calcium oxalate stone and recurrent urinary tract infections had resulted in a progressive deterioration in kidney function over a period of 20 years. She underwent living donor kidney transplantation; however, her kidney function progressively deteriorated, despite transplantation. A biopsy of the renal allograft revealed GIN with granulomatous vasculitis accompanied by calcium oxalate crystals. These as well as the laboratory findings indicated a diagnosis of sarcoidosis. We considered that the aggravated granulomatous inflammation on the allograft was caused by recurrent sarcoidosis accompanied by hyperoxaluria.

Sarcoidosis in the renal allograft of a recipient whose primary disease was autosomal dominant polycystic kidney disease

“…Sarcoidosis is a multisystem granulomatous disorder. Various extrarenal lesions have been reported among the cases of sarcoidosis involving the renal allograft, which included lesions in the lung [1,4,5], liver [4], intestine [3], central nervous system [1], lacrimal and parotid glands [6], uvea [5,7,8], and multiple joints [5]. In our case, extrarenal sarcoidosis only involved enlarged mediastinal and bilateral hilar lymph nodes.…”

“…Ten cases of sarcoidosis involving a renal allograft have been reported; in seven of these cases, the primary renal disease was sarcoidosis [1,[4][5][6]8]. One case of calcium oxalate stones and recurrent urinary tract infections was reported, and the histological analysis of native kidney tissue revealed granulomas [3]; and the etiology of the primary renal disease was unknown in two cases [2,7]. Although the recurrence rate of sarcoidosis in renal allografts is unclear, it was reported that among the 10 recipients of kidney transplants whose primary renal disease was sarcoidosis, and who were followed for a median period of 52 (range 18-196) months, recurrence of sarcoidosis in their renal allograft was diagnosed in three [4].…”

“…Replacing CS with everolimus might have led to the progression of sarcoidosis. Of the 10 previous cases of sarcoidosis involving a renal allograft, maintenance immunosuppression consisted of a calcineurin inhibitor (CNI), MMF, and CS in 5 cases [1,[3][4][5], CNI, azathioprine (AZA), and CS in 2 cases [4,6], CNI and CS in 1 case [7], AZA and CS in 1 case [8], and not reported in 1 case [1]. Almost all the recipients with recurrent sarcoidosis in their renal allograft received maintenance immunosuppressive therapy that included CS.…”

“…2), but there were no active lesions in the lungs, and lesions due to sarcoidosis were not seen in other organs before kidney transplantation. By computed tomography, the total kidney volume was estimated to be 1907 cm 3 . No findings suggestive of sarcoidosis that involved the heart or uveas were observed.…”

“…Sarcoidosis is a non-caseating granulomatous disease of unknown etiology involving multiple organs. Patients whose primary renal disease was sarcoidosis or unknown have been reported as developing sarcoidosis in their renal allograft [1][2][3][4][5][6][7][8]. To the best of our knowledge, there have not been any reports of sarcoidosis that has developed in the renal allograft of a recipient whose primary renal disease was not sarcoidosis.…”