Acute interstitial nephritis due to methicillin

Galpin, Jeffrey E.; Shinaberger, James H.; Stanley, Thomas M.; Blumenkrantz, Michael J.; Bayer, Arnold S.; Friedman, Gerald S.; Montgomerie, John Z.; Guze, Lucien B.; Coburn, Jack W.; Glassock, Richard J.

doi:10.1016/0002-9343(78)90793-3

Cited by 242 publications

(79 citation statements)

References 29 publications

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“…Some studies have suggested a positive influence on the complete recovery of renal function in those patients who received steroids [17][18][19]. A multicenter study of González et al [20] showed that, in biopsy-proven DI-AN patients, final creatinine levels were found to be better (lower) in the steroid administered group than in the nonsteroid (control) group.…”

Section: Discussionmentioning

confidence: 99%

Acute kidney injury due to acyclovir

et al. 2012

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Acyclovir is an antiviral agent widely used in herpetic infections in children. Although acyclovir is generally well tolerated, severe nephrotoxicity has been reported in some cases. In this report, we present a 16-yearold girl who developed acute renal failure due to acyclovir treatment and who needed repetitive hemodialysis. Renal biopsy was performed in order to confirm the diagnosis. A diagnosis of drug-related acute tubulointerstitial nephritis with focal tubular necrosis was made.

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Section: Discussionmentioning

confidence: 99%

Acute kidney injury due to acyclovir

et al. 2012

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“…Although the effectiveness of steroid treatment in drug-induced TIN is controversial, some studies have shown efficacy of introduction of steroid treatment in the early phase [15][16][17][18]. We treated our patient with steroid because there was severe infiltration of inflammatory cells in the renal biopsy specimens and the elevated ESR/CRP levels reflected organ inflammation.…”

Section: Discussionmentioning

confidence: 99%

A case of acetaminophen-induced acute tubulointerstitial nephritis in adult

et al. 2017

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We report a case of allergic acute tubulointerstitial nephritis (TIN) induced by acetaminophen in a 48-year-old Japanese man with no past medical history. Two days after receiving the non-steroidal anti-inflammatory drug (NSAID) loxoprofen for left shoulder pain, he developed cold symptoms such as fever and sore throat. He then took a 300 mg dose of acetaminophen three times a day and a 100 mg dose of minocycline hydrochloride twice a day for 7 days. Because there was no improvement in his symptoms, he consulted a local clinic again, where blood tests revealed renal insufficiency, and he was, then, referred to our hospital for evaluation of kidney function. Renal biopsy revealed acute TIN, and Ga-67 scintigraphy showed diffuse uptake in bilateral kidneys. A drug-induced lymphocyte stimulation test (DLST) was positive for acetaminophen and negative for loxoprofen and minocycline. Based on these findings, we made a diagnosis of acetaminophen-induced TIN. We treated the patient with three courses of semi-pulse steroid therapy, after which his fever went down, and his serum creatinine level recovered from 2.09 to 1.43 mg/dL. Although we medical doctors think that therapeutic dose of acetaminophen retains high safety, it is important to keep in mind that acetaminophen can cause allergic acute TIN.

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“…For years, urinary eosinophils have been used as biomarkers for acute interstitial nephritis (AIN). The characteristics that would make eosinophiluria a useful biomarker for AIN include that (1) eosinophils are consistently present in the urine of patients with AIN (i.e., AIN is characterized by an eosinophilic interstitial infiltrate), (2) eosinophils are absent in the setting of another etiology of AKI (i.e., other renal and extrarenal diseases are not associated with eosinophiluria), and (3) a predetermined percentage of eosinophils is easily visualized in the urine when present (i.e., excellent stain performance).…”

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confidence: 99%

“…The earliest description of this test as a biomarker for AIN was by Galpin et al (2) in 1978. Using the Wright stain, nine of nine cases of methicillin-associated AIN had urinary eosinophils.…”

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confidence: 99%

“…However, although b-lactam drugs are classically associated with this finding, not all medications promote an eosinophilic infiltrate (i.e., nonsteroidal anti-inflammatory drugs). In fact, four studies focusing on drug-induced AIN showed that only 24 of 40 (60%) patients had a significant eosinophilic interstitial infiltrate on biopsy (2,3,11,12). Regardless of the explanation, the paper by Muriithi et al (10) should signal the end of urinary eosinophils as a useful biomarker for AIN and provide nephrologists with data to definitively recommend against this test.…”

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Urinary Eosinophils in AIN

Perazella

Bomback

2013

Clinical Journal of the American Society of Nephrology

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Urinary biomarkers of kidney injury are an area of ongoing research in nephrology. For years, urinary eosinophils have been used as biomarkers for acute interstitial nephritis (AIN). The characteristics that would make eosinophiluria a useful biomarker for AIN include that (1) eosinophils are consistently present in the urine of patients with AIN (i.e., AIN is characterized by an eosinophilic interstitial infiltrate), (2) eosinophils are absent in the setting of another etiology of AKI (i.e., other renal and extrarenal diseases are not associated with eosinophiluria), and (3) a predetermined percentage of eosinophils is easily visualized in the urine when present (i.e., excellent stain performance).As early as 1967, urinary eosinophils were reported in rejection episodes after kidney transplantation, suggesting that they were associated with "kidney inflammation" (1). The earliest description of this test as a biomarker for AIN was by Galpin et al. (2) in 1978. Using the Wright stain, nine of nine cases of methicillin-associated AIN had urinary eosinophils. Six of nine cases had biopsy-proven AIN, with eosinophils within the renal interstitium and occasionally, tubular lumens; 0 of 43 patients with AKI from another diagnosis had eosinophiluria. These data implied that eosinophiluria was a sensitive and specific test for AIN. Linton et al. (3) subsequently described eosinophiluria in six of nine patients with drug-induced AIN. Eight patients had biopsy-proven AIN, with five patients having prominent interstitial eosinophils. Overall, these two small studies suggested that eosinophiluria might be a reasonably good biomarker for AIN.Additional work on this subject by Corwin et al. (4) examined the clinical correlates of eosinophiluria using the Wright stain in 65 patients. AIN was diagnosed in 9 of 65 patients, with eosinophiluria noted in 8 of 9 of these cases, replicating previous data. However, urinary eosinophils were also shown in 27 of 56 patients with diagnoses other than AIN ( Table 1), suggesting that the test was rather nonspecific. Corwin et al. (4) concluded that using a .5% eosinophil cutoff might identify a group with higher probability of having AIN. However, 6 of 56 non-AIN patients and only 4 of 9 AIN patients met this cutoff, which (not unexpectedly) improved specificity but reduced sensitivity. The lack of sensitivity of urinary eosinophils was further emphasized in a review paper based on data from 10 studies examining drug-induced AIN showing that eosinophiluria was present in only 59% (19/32) of biopsy-proven AIN cases (5).Because low sensitivity was the major concern, Nolan et al. (6) renewed interest in eosinophiluria as an AIN biomarker with a New England Journal of Medicine publication that hailed the Hansel stain as a better method to visualize urinary eosinophils. This stain was chosen based on its use in identifying eosinophils in nasal, bronchial, and ocular secretions of patients with allergy-related diseases; 92 patients with an active urine sediment were identified by the nephrolo...

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Acute interstitial nephritis due to methicillin

Cited by 242 publications

References 29 publications

Acute kidney injury due to acyclovir

Acute kidney injury due to acyclovir

A case of acetaminophen-induced acute tubulointerstitial nephritis in adult

Urinary Eosinophils in AIN

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