title: Granulomatous interstitial nephritis after nonsteroidal anti-inflammatory drugs.
abstract: Electrolyte and renal hemodynamic imbalance, acute interstitial nephritis with nephrotic-range proteinuria, papillary necrosis, tubular necrosis, and vasculitis are complications after intake of nonsteroidal anti-inflammatory drugs (NSAID). We report on 2 cases of biopsy-proven granulomatous interstitial nephritis with rapidly progressing renal insufficiency. Patient 1 was on ketoprofen for 7 months and indomethacin for 10 weeks before admission to hospital. The medication was not discontinued and renal insufficiency progressed to end-stage renal failure. Renal function did not respond to steroid and tuberculostatic treatment. Patient 2 was on diclofenac for 6 months and indomethacin for 7 weeks before admission to hospital. These drugs were withdrawn at diagnosis and renal function rapidly improved. We conclude that granulomatous interstitial nephritis may be a complication of NSAID medication indicating a cell-mediated immunologic disorder. False diagnosis (sarcoidosis, tuberculosis) may lead to end-stage renal disease (case 1). Discontinuation of medication obviates further therapy (case 2).
authors.affiliation: Department of Medicine, Free University of Berlin.
authors.forename: A
authors.initials: A
authors.lastname: Schwarz
authors.forename: P H
authors.initials: PH
authors.lastname: Krause
authors.forename: F
authors.initials: F
authors.lastname: Keller
authors.forename: G
authors.initials: G
authors.lastname: Offermann
authors.forename: M J
authors.initials: MJ
authors.lastname: Mihatsch
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D004008:Diclofenac / Q000009:adverse effects; D005260:Female; D006801:Humans; D007213:Indomethacin / Q000009:adverse effects; D007660:Ketoprofen / Q000009:adverse effects; D009395:Nephritis, Interstitial / Q000139:chemically induced*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D004008:Diclofenac; D007660:Ketoprofen; D007213:Indomethacin