title: [Two cases of interstitial nephritis with primary Sjögren's syndrome successfully treated by steroid therapy].
abstract: We have experienced two cases of interstitial nephritis with Sjögren's syndrome successfully treated by steroid therapy. Case 1. A 50-year-old woman was admitted because of rash and arthralgia of the limb. Although her renal function was normal, serum IgG was extremely high and gallium-67 scintigrams indicated abnormal uptake in both kidneys with swelling on CT scans. Renal biopsy specimens showed a patchy dense interstitial infiltration of lymphocytes, monocytes and partly plasma cells with tubular cell atrophy. To suppress an excessive immune reaction, oral prednisolone was administrated at a dose of 30 mg/day. Six weeks after inception of the therapy, re-biopsy specimens showed a decrease in interstitial infiltration, particularly plasma cells, and interstitial fibrosis did not progress. After 8 weeks, the serum IgG level was normalized. Case 2. A 57-year-old woman was found to have renal involvement(serum creatinine level: 2.2 mg/dl) and anemia. Clinical findings suggested primary Sjögren's syndrome with renal tubular acidosis. Renal biopsy specimens showed a moderate to severe interstitial infiltration of inflammatory cells. After inception of steroid therapy(prednisolone 40 mg/day), renal involvement and renal anemia gradually improved. The renal function has been kept stable(serum creatinine level: 1.5 mg/dl) for 9 years by low-dose steroid therapy. These two cases suggest that steroid therapy plays two important roles: controlling of the acute immune reaction that causes renal fibrosis to progress in case 1, and long-term preservation of the renal function by the continuous use of low-doses in case 2.
authors.affiliation: First Department of Internal Medicine, Miyazaki Medical College, Miyazaki, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Komatsu
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Hara
authors.forename: Masao
authors.initials: M
authors.lastname: Kikuchi
authors.forename: Michitaka
authors.initials: M
authors.lastname: Matsumoto
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Yamada
authors.forename: Yuji
authors.initials: Y
authors.lastname: Sato
authors.forename: Shouichi
authors.initials: S
authors.lastname: Fujimoto
authors.forename: Tanenao
authors.initials: T
authors.lastname: Eto
mesh_terms: D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D008875:Middle Aged; D009395:Nephritis, Interstitial / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D011239:Prednisolone / Q000008:administration & dosage*; D012859:Sjogren's Syndrome / Q000150:complications*
chemical_list: D000893:Anti-Inflammatory Agents; D011239:Prednisolone