Wegener's granulomatosis presenting as acute suppurative interstitial nephritis

Abstract

A 78 year old man presented with acute renal failure following a prolonged respiratory illness. A renal biopsy demonstrated severe suppurative interstitial nephritis with normal glomeruli. After nine weeks of antibiotics he remained anuric and a second biopsy demonstrated pauci-immune, necrotising glomerulonephritis. His subsequent clinical course was consistent with a diagnosis of Wegener's granulomatosis and antineutrophil cytoplasmic antibodies (ANCA) were detected. This is the first reported case of Wegener's granulomatosis presenting with an isolated tubulointerstitial lesion. (J Clin Pathol 2001;54:787-789)

Transformation from Tubulointerstitial Nephritis to Crescentic Glomerulonephritis: An Unusual Presentation of ANCA-Associated Renal Vasculitis

“…The patient remained dialysis dependent despite treatment with corticosteroids, and cyclophosphamide was commenced thereafter. [2] In our patient, the first renal biopsy, with adequate tissue analyzed to exclude the possibility of focal glomerulonephritis that was not sampled in the biopsy specimen, demonstrated isolated TIN without glomerular lesions. However, there were no detectable common causes of TIN.…”

“…To our knowledge, only one case of WG with this unique presentation has been described in the literature. [2]…”

Tubulointerstitial Nephritis Caused by Peritubular Capillaritis Accompanied by Cryoglobulinemia

“…Second, peritubular capillaritis might represent an early event in the course of cryoglobulinemic vasculitis. Transformation from tubulointerstitial nephritis with peritubular capillaritis to crescentic glomerulonephritis in ANCA-associated vasculitis has been reported (25). On average, renal disease in cryoglobulinemic vasculitis is detected at approximately 2.5 years after the onset of disease (26).…”

The level of urinary α1 microglobulin excretion is a useful marker of peritubular capillaritis in antineutrophil cytoplasmic antibody associated vasculitis

“…However, Nakabayashi et al reported 3 cases (4.5 %) of tubulointerstitial nephritis caused by peritubular capillaritis (PTC) without crescentic glomerulonephritis in a total sample of 66 renal biopsy specimens [4]. In addition, some case reports of ANCA-associated vasculitis described tubulointerstitial nephritis with normal glomeruli in the first renal biopsy and necrotizing crescentic glomerulonephritis in the second renal biopsy [5,6]. These reports suggest that ANCA-associated vasculitis is a condition that involves arteriolitis, crescentic glomerulonephritis, and PTC, and that the characteristics of each are independent.…”