title: Drug-induced granulomatous interstitial nephritis in a pediatric patient.
abstract: Acute interstitial nephritis (AIN) is a known cause of acute renal failure in children. In most instances, drug therapy is the offending agent. Although granuloma formation has been observed in drug-induced interstitial nephritis, it is not a commonly associated manifestation. This is a case of a 15-year-old white female with Tetralogy of Fallot and pulmonary atresia who developed acute renal failure secondary to drug-induced interstitial nephritis and renal granulomas. In addition to interstitial edema with eosinophils and lymphocytes, her renal biopsy showed interstitial granulomas, immune complexes within tubular basement membranes, and the unusual feature of multinucleated giant cells engulfing tubules. Her acute renal failure resolved after the withdrawal of antibiotics and the initiation of intravenous steroid therapy.
authors.affiliation: Department of Pediatrics, University of California at San Francisco, San Francisco, CA, USA.
authors.forename: James E
authors.initials: JE
authors.lastname: Tong
authors.forename: David N
authors.initials: DN
authors.lastname: Howell
authors.forename: John W
authors.initials: JW
authors.lastname: Foreman
mesh_terms: D058186:Acute Kidney Injury / Q000188:drug therapy / Q000209:etiology; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D000936:Antigen-Antibody Complex / Q000378:metabolism; D001485:Basement Membrane / Q000378:metabolism / Q000473:pathology; D001706:Biopsy; D002444:Cefuroxime / Q000009:adverse effects*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006099:Granuloma / Q000139:chemically induced* / Q000150:complications / Q000175:diagnosis; D006801:Humans; D007668:Kidney / Q000378:metabolism / Q000473:pathology; D009395:Nephritis, Interstitial / Q000139:chemically induced* / Q000150:complications / Q000175:diagnosis; D011241:Prednisone / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D000936:Antigen-Antibody Complex; D005938:Glucocorticoids; D002444:Cefuroxime; D011241:Prednisone