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Abstract: FR-PO179

Acute Interstitial Nephritis Secondary to Sarcoid-Like Reaction After Autologous Bone Marrow Transplantation

Session Information

Category: Onconephrology

  • 1600 Onconephrology

Authors

  • Lutf, Luciana Gil, Hospital das Clinicas da Faculdade de Medicina de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
  • Strufaldi, Fernando Louzada, Hospital das Clinicas da Faculdade de Medicina de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
  • Cavalcante, Livia Barreira, Hospital das Clinicas da Faculdade de Medicina de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
  • Caires, Renato Antunes, Universidade de Sao Paulo Instituto do Cancer do Estado de Sao Paulo, Sao Paulo, São Paulo, Brazil
  • Mattedi, Francisco Zanotelli, Universidade de Sao Paulo Instituto do Cancer do Estado de Sao Paulo, Sao Paulo, São Paulo, Brazil
  • Costalonga, Elerson, Universidade de Sao Paulo Instituto do Cancer do Estado de Sao Paulo, Sao Paulo, São Paulo, Brazil
  • Shcolnik Szor, Roberta, Universidade de Sao Paulo Instituto do Cancer do Estado de Sao Paulo, Sao Paulo, São Paulo, Brazil
  • Costa e Silva, Veronica Torres, Universidade de Sao Paulo Instituto do Cancer do Estado de Sao Paulo, Sao Paulo, São Paulo, Brazil
Introduction

Sarcoid-like(SL) disease is a systemic inflammatory granulomatous reaction triggered by a known underlying factor, such as immunosuppression. We report a case of acute interstitial nephritis(AIN) in the context of an SL systemic disease associated with humoral immunodeficiency in the post autologous stem cell transplant(ASCT) period.

Case Description

A 69-y-old woman diagnosed with non-Hodgkin mantle cell lymphoma was treated with Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone regimen followed by consolidation with ASCT in first complete remission. In November 2019, she had Coombs-negative hemolytic anemia and a PET-CT revealed abnormal uptake in mediastinal and supraclavicular lymph nodes(LN). To rule out relapse, LN and bone marrow (BM) biopsies were performed, which demonstrated chronic inflammatory granuloma without necrosis. At this point, serum creatinine was 1.0 mg/dL, and combined hypogammaglobulinemia was observed. In July 2021, the patient was referred to the Nephrology clinic due to an insidious increase in Scr (1.8 > 2.3 > 2.8mg/dL in five months). Albeit discrete proteinuria, no other abnormalities were found. No urinary or systemic complaints were referred. Blood pressure was normal. No edema was detected. Percutaneous renal biopsy demonstrated AIN without granuloma and a negative immunofluorescence. Considering a diagnosis of sarcoid-like disease associated with post-SCT immunodeficiency, prednisone at 1mg/kd/day was started, with decline of Scr to 2.0 mg/dL two weeks later. After two months, methotrexate (10mg/week) was started with wean from steroids. The patient has been followed up with sustained Scr of 1.5mg/dL.

Discussion

Acquired immunodeficiencies may be associated with SL granulomatous disease. We postulate that a potential B-cell reconstitution deficiency and consequent hypogammaglobinemia could create an immunologic environment for a granulomatous disease. This is the first reported acute IN case secondary to SL reaction after an SCT.