Clinical Characterization of Drug-Induced Allergic Nephritis

Abstract

To elucidate the clinical characterization of drug-induced allergic nephritis (DIAN), we analyzed the cases attending our department. We now report on the 14 cases of DIAN due to administration of penicillin in 2 cases, cephem antibiotics in 6 cases, nonsteroidal anti-inflammatory drugs in 4 cases and new quinolone anticidal drugs in 2 cases. With 1 exception, all these cases reached the stage of acute renal failure after taking these drugs for 2–13 days, followed by characteristic allergic symptoms such as fever, skin eruptions and serum IgE elevation in 5 of the 14 cases. A lymphocyte stimulation test (LST) with the suspected drugs proved to be positive in 10 of the 12 cases examined, and the uptake of ⁶⁷Ga in the kidneys was extremely positive in all 6 cases examined, reflecting the natural course of this disease. Furthermore, there were some cases where ⁶⁷Ga accumulated in the kidneys in spite of the negative result of LST examination. In all of these cases, a needle or open renal biospy was performed, and acute tubulointerstitial nephritis (AIN) was diagnosed. Almost all cases were treated with glucocorticoid for AIN or dialysis for acute uremic symptoms several times. However, 4 of the 14 cases could not return to normal condition in spite of these forms of treatment. We would therefore like to suggest that LST and ⁶⁷Ga scintigram are useful diagnostic tools for DIAN as an alternative to renal biopsy.

Repeat renal biopsy in a girl with tubulointerstitial nephritis and uveitis syndrome

“…The creatinine clearance was 95.5 ml/min per 1.73 m 2 . A 67-gallium scintigram for tubulointerstitial nephritis [10] demonstrated an abnormal uptake in the kidneys. A percutaneous renal biopsy was performed on hospital day 4.…”

Hypercoagulopathy with Piperacillin Administration in Osteomyelitis.

“…The pathogenesis of hypercoagulable conditions is multifactorial with mechanisms including release of proteins by activated lymphocytes and eosinophils, and co-morbid predisposing factors such as bed rest. In the patient reported here, the significantly high concentration of ECPin the serum suggested that he had had a hypersensitivity reaction, possibly to PIPC, and that activated eosinophils might play a role in the pathogenesis of hypercoagulopathy and acute renal failure (8,16). Weconsider it unlikely that any causes other than the administration of PIPCwere responsible for the present reactions.…”

Successful Steroid Therapy for Cefdinir-induced Acute Tubulointerstitial Nephritis with Progressive Renal Failure.

“…As the serumcreatinine concentration and urinalysis were normal 4 months prior to the onset of acute tubulointerstitial nephritis, and cefdinir was the only drug prescribed during the pre-onset period, cefdinir is the likely cause. Shibasaki et al have concluded that the drug lymphocyte stimulation test is applicable to the etiologic diagnosis of drug-induced acute tubulointerstitial nephritis, finding a sensitivity in identifying the suspected agent of 75% (9/12), while all drugs administered except for the suspected agents tested negative (9). Therefore, we concluded that cefdinir caused the acute tubulointerstitial nephritis in this case.…”