Granulomatous interstitial

Granulomatous interstitial nephritis (SEDA-12, 94) and two cases of interstitial cystitis have been described during long-term treatment with allopurinol (SEDA-21,108). 

Other rare complications have been seldom reported, namely cryoglobulinemia with evidence of disseminated BCG infection (16), ruptured mycotic aneurysm of the abdominal aorta (17), bladder wall calcification (18), rhabdomyolysis (19), iritis or conjunctivitis with arthritis or Reiter s syndrome (20,21), and severe acute renal insufficiency due to granulomatous interstitial nephritis, which can occur even in the absence of other systemic complications (22). 

Dihydrocodeine was implicated in cases of granulomatous interstitial nephritis (3). 

Singer DR, Simpson JG, Catto GR, Johnston AW. Drug hypersensitivity causing granulomatous interstitial nephritis. Am J Kidney Dis 1988 ll(4) 357-9. 

Fervenza FC, Kanakiriya S, Kunau RT, Gibney R, Lager DJ. Acute granulomatous interstitial nephritis and colitis in anticonvulsant hypersensitivity syndrome associated with lamotrigine treatment. Am J Kidney Dis 2000 36(5) 1034-40. 

Cryst C, Hammar SP. Acute granulomatous interstitial nephritis due to co-trimoxazole. Am J Nephrol 1988 8(6) 483-8. 

Lien YH, Hansen R, Kern WF, Bangert J, Nagle RB, Ko M, et al. Ciprofloxacin-induced granulomatous interstitial nephritis and localized elastolysis. Am J Kidney Dis. 1993 Oct 22(4) 598-602. 

Ramalakshmi S, Bastacky S, Johnson JP. Levofloxacin-induced granulomatous interstitial nephritis. Am J Kidney Dis. 2003 Feb 41 (2) E7. 

Nephrotoxicity of bisphosphonates is a known complication of this compound class, often exacerbated by diseases that compromise renal function, such as multiple myeloma, and by concomitant use of antineo-plastic agents, steroids, and radiation therapy. The first reports of tubulointerstitial damage after treatment with etidronate and clodronate appeared more than 2 decades ago [60]. Subsequently, acute tubular necrosis, focal segmental glomerulosclerosis (FSGS), and granulomatous interstitial nephritis have been reported in renal biopsies from predominantly cancer patients exposed to several bisphosphonates, often at high i.v. doses. 

Alendronate therapy of a patient with chronic lymphocytic leukaemia has been associated with the onset of acufe granulomatous interstitial nephritis, a relatively rare renal pathology primarily caused by adverse drug reactions [27]. In this case, treatment with oral alendronate was initiated 2 weeks before... 

McAllister CJ, Horn R, Havron A, Abramson JH. Granulomatous interstitial nephritis a complication of heroin abuse. 5 Med J 1979 72 162-165. 

Sarcoidosis is a multisystem disorder associated with chronic granulomatous interstitial nephritis. Biochemical abnormalities include hypercalcemia, hypercalciuria, and elevated serum ACE activity. The condition may be effectively treated with steroids. 

Seven cases of granulomatous interstitial nephritis in the absence of extrarenal sarcoid. Nephrol Dial Transplant 2003 18 280-4. 

A 19-year-old man with ulcerative colitis was given cefprozil 1 g/day, mesalazine 3 g/day, methylprednisolone 32 mg/day, and ranitidine 300 m day. The cefprozil and ranitidine were withdrawn after 10 days and the methylprednisolone was tapered to zero over the next 3 months. The mesalazine was discontinued after 1 month because of vomiting and diarrhea. He was given sulfasalazine 2 g/day, but 7 months later developed fatigue, nausea, fever, and nocturia. He had raised serum urea and creatinine concentrations, and abdominal ultrasound showed normal kidneys. Sulfasalazine was withdrawn, but over the next 4 days, the serum urea and creatinine increased further and a renal biopsy showed changes compatible with granulomatous interstitial nephritis. Renal function recovered completely after a few days treatment with methylprednisolone. 

Granulomatous interstitial nephritis has been reported in a 25-year-old man who had been taking phenytoin 300 mg/day [250- ]. 

Ram R, Swarnalatha G, Prasad N, Prayaga A, Dakshina Murthy KV. Granulomatous interstitial nephritis after prolonged use of phenytoin. Saudi J Kidney Dis Transpl 2009 20(1) 131-3. 

Urinary tract Acute renal insufficiency due to granulomatous interstitial nephritis associated with long-term prophylactic nitrofurantoin improved after nitrofurantoin withdrawal [139 ]. 

Namagondlu G, Low SE, Seneviratne R, Banerjee A. Acute renal failure from nitrofurantoin-induced acute granulomatous interstitial nephritis. QJM 2010 103 (1) 49-52. 

Cheung OY, Muhm JR, Helmers RA, et al. Surgical pathology of granulomatous interstitial pneumonia. Ann Diagn Pathol 2003 7 127-138. 

Although 20% of patients with sarcoidosis may demonstrate granulomas in the kidneys, the clinical syndrome of granulomatous interstitial nephritis is rare (183). Glomerulonephritis of the membranous, mesangioproliferative, and cresentic types as well as IgA nephropathy have been reported sporadically (183). 

Urinary tract A 69-year-old woman developed biopsy-proven acute granulomatous interstitial nephritis while on levetiracetam 1000 mg/day. She made a complete recovery after cessation of the levetiracetam [103 ]. A 45-year-old man similarly developed interstitial nephritis with intractable nausea and vomiting while taking levetiracetam for seizures in the setting of a low grade glioma. The medication was changed and his renal function rapidly improved to his baseline [104 ]. 

Chau K, Yong J, Ismail K, Griffith N, Liu M, Makris A. Levetiracetam-induced severe acute granulomatous interstitial nephritis. CUn Kidney... 

In a case report, a 53-year-old woman status post kidney transplant switched to sirolimus 2 months before and presented with fever, progressive dyspnoea and hypoxia for 2 weeks. A CT scan of the chest revealed bilateral ill-defined patchy ground glass opacities. Extensive investigations were negative for infection. Video-assisted thoracoscopic biopsy showed granulomatous interstitial pnemnonitis. Symptoms and infiltrates resolved after sirolimus discontinuation and corticosteroid treatment [45 ]. 

Ussavarungsi KEA, Laski M, Raj R, Nugent K. Sirolimus induced granulomatous interstitial pneumonitis. Respir Med Case Rep 2012 7 8-11. 

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