Post-transplant neutrophilic interstitial nephritis--an important cause of graft dysfunction.
Post-transplant neutrophilic interstitial nephritis (NIN) is characterized by an interstitial infiltrate consisting of polymorphonuclear cells that leads frequently to acute graft dysfunction. In 220 graft biopsies performed because of renal dysfunction over 2 years in our unit, 11 (5%) diagnoses of NIN were made. Only two patients had chronic pyelonephritis as original disease. Four patients had urological problems before transplantation. After transplantation, five patients had urinary tract infection, one had urethral stenosis, two had vesicourethral reflux and one patient had a perinephritic abscess. Seven patients had fever (63%). Only in six patients did urine culture lead to microorganism isolation. After 6 months, only two patients had a serum creatinine level < 1.4 mg/dl, five patients had abnormal function, three had lost their grafts, and one patient had died with sepsis. We conclude that 5% of the biopsies performed in our center disclosed NIN, an entity that causes graft dysfunction and progresses frequently to chronic renal failure. In some cases, no infectious etiology could be detected.
Renal Transplantation Unit, São Paulo University, Brazil.
M C
MC
de Castro
L B
LB
Saldanha
W
W
Nahas
D S
DS
David
S
S
Arap
E
E
David-Neto
E
E
Sabbaga
L E
LE
Ianhez
D005260:Female; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D009395:Nephritis, Interstitial / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D009504:Neutrophils