Abstract: PO1502
Granulomatous Interstitial Nephritis: A Rare Cause of AKI
Session Information
- Glomerular Diseases: The Excitement of Clinical Cases
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1202 Glomerular Diseases: Immunology and Inflammation
Authors
- Carias Martinez, Karla G., Johns Hopkins Medicine, Baltimore, Maryland, United States
- Srialluri, Nityasree, Johns Hopkins Medicine, Baltimore, Maryland, United States
- Giannini, Gabriel A., Johns Hopkins University Department of Pathology, Baltimore, Maryland, United States
- Monroy-Trujillo, Jose Manuel, Johns Hopkins University, Baltimore, Maryland, United States
Introduction
Granulomatous interstitial nephritis is a rare finding identified in < 1 % of native kidney biopsies. The most frequent etiology is drug related followed by systemic granulomatous conditions.
Case Description
54-year-old African American male with diabetes, obesity, CKD stage 3 with a baseline Creatinine of 1.4 mg/dL and history of remote sarcoidosis was admitted with epididymo-orchitis treated with multiple antibiotic regimens including beta lactams; complicated with MRSA bacteremia and AKI with a creatinine peak of 3 mg/dL. Laboratory studies showed: Normal complement levels, serum calcium of 8.4 mg/dL with normal ACE level and urinalysis with no protein 9 WBC/HPF and 10 RBC/HPF. CXR showed prominent bilatral hila and patchy infiltrates.Renal Biopsy was done and revealed granulomatous interstitial nephritis, focal glomerulonephritis (GN) consistent with infectious related GN with focal acute tubular injury and atrophy with interstitial fibrosis. Image 1 shows giant cells on PAS . Patient was started on prednisone 40 mg daily for 2 weeks and subsequent taper. Was referred to the sarcoidosis clinic due to his remote history and found to have multisystemic granulomatous disease affecting the pulmonary, hepatic and ymphatic systems.
Discussion
Granulomatous interstitial nephritis (GIN) is an uncommon histologic diagnosis. It is known to be associated with antibiotic use and granulomatous disorders like sarcoidosis. The incidence of renal sarcoidosis ranges from 7-17 % manifesting as GIN or with renal damage due to altered calcium homeostasis. Corticosteroids are considered the mainstay of therapy.
Image 1. PAS Staining