Granulomatous interstitial nephritis: Our experience of 14 patients

Abstract

Granulomatous interstitial nephritis (GIN) is a rare condition. Drugs, infections, immune processes, and foreign body reaction are the main causes. We identified a total of 14 patients with GIN during a period of 13 years in 2798 renal biopsies. There were 8 males and 6 females in the age range of 20-70 (mean 35 ± 12) years. The serum creatinine at presentation was 6.7 ± 3.8 (range: 2.3-14.7) mg/dl. In nine patients tuberculosis was the causative agent. Drugs (n = 2) and Wegener's granulomatosis (n = 1) were other etiologies. Systemic lupus erythematosis (SLE) and Immunoglobulin A nephropathy (IgAN) were seen in one patient each. Patients with tuberculosis were treated with antituberculous therapy and three of them improved. Four out of six patients who required dialysis at presentation remained dialysis dependent, one of whom underwent renal transplantation. Two patients progressed to end stage renal disease after 7 years and 9 years each. The patients with drug induced GIN had improvement in renal function after prednisolone treatment. Patients with SLE, and Wegener's granulomatosis responded to immunosuppression. Patient with IgAN was on conservative management. Finally, six patients were on conservative management for chronic renal failure.

Renal failure due to granulomatous interstitial nephritis in native and allograft renal biopsies: experience from a tertiary care hospital

“…9 In Indian subcontinent, tuberculosis has been reported as the commonest cause of granulomatous interstitial nephritis in native renal biopsies. 10 Our study is in agreement with the prior study from India. Majority of the patients in our series presented with advanced renal failure with minimal proteinuria as described in the study by Joss et al 11 Chapagain et al 12 have described 25 cases of tuberculous tubulointerstitial nephritis of which 17 patients had biopsy proven granulomatous interstitial nephritis.…”

Granulomatous interstitial nephritis secondary to chronic lymphocytic leukemia/small lymphocytic lymphoma

“…Granulomas are composed of activated macrophages, also called "epithelioid cells," with or without giant cells. The renal biopsy incidence of GIN ranges from 0.5% to 5.9% [1][2][3][4][5]. In our experience, GIN accounts for 26% of cases of acute interstitial nephritis [6].…”

“…In our experience, GIN accounts for 26% of cases of acute interstitial nephritis [6]. Most cases of GIN in the developed countries are due to drugs or sarcoidosis [1,2], whereas infections, particularly by mycobacteria or fungi, are the most common etiology in the developing countries [4]. Antibiotics and nonsteroidal anti-inflammatory drugs are the most frequent classes of drugs to cause GIN [1,2], although there have been many case reports of GIN linked to other therapeutic agents, including analgesics, diuretics, anticoagulants, and others (reviewed in Javaud et al [2]).…”

Granulomatous Interstitial Nephritis in Children Resulting from Wegener’s Granulomatosis, Crohn’s Disease, or Sarcoidosis

“…In addition, the etiological structure of GIN can vary in different countries: in more developed countries, GIN is more probably related to drugs and sarcoidosis, whereas in less developed regions, it is likely to be associated with infections [2]. However, the most common causes are drug therapy and infection, and drugs (NSAIDs, antimicrobials, anticonvulsants, diuretics, and allopurinol) [3][4][5] account for 9-45% [6,7] up to 55-70% [1], according to different studies.…”

“…The main infectious factors in the onset of this pathology, especially in immunocompromised patients, include mycobacteria [7] and fungi [1,7]. GIN can be associated with HIV infection [8] and the influenza A (H1N1) virus [9].…”