Giant cell tubulitis with tubular basement membrane immune deposits: a report of two cases after cardiac valve replacement surgery.
This paper presents two elderly patients who had normal baseline renal function and had stenotic valvular lesions secondary to rheumatic fever and underwent aortic valve replacements with mechanical valves. Both patients developed acute renal failure after cardiac valve replacement procedures. The renal biopsies revealed acute granulomatous tubulointerstitial nephritis. The unique histologic features were tubular basement membrane (TBM) immune complex deposition detected by both immunofluorescence and electron microscopy and prominent multinucleated giant cells surrounding intact TBM. The temporal relationship to the surgical procedure and the subsequent recovery of the patients' renal functions upon therapy suggested that the renal failure may have been due to an allergic drug reaction from the perioperative exposure to unknown agents, such as prophylactic antibiotics and furosemide. The literature on TBM immune complex deposition was reviewed, and the pathophysiologic mechanisms that may account for the similarities between the clinicopathologic features of these two cases were examined. These two cases expand the histopathologic spectrum of previously described cases of putative drug-induced acute tubulointerstitial nephritis.
Chang
Anthony
A
Department of Pathology, University of Washington Medical Center, Seattle, Washington, USA. anthony.chang@uchospitals.edu
Peutz-Kootstra
Carine J
CJ
Kowalewska
Jolanta
J
Logar
Christine M
CM
Gitomer
Jeremy J
JJ
Davis
Connie L
CL
Shankland
Stuart J
SJ
Alpers
Charles E
CE
Smith
Kelly D
KD
D058186:Acute Kidney Injury / Q000209:etiology* / Q000276:immunology / Q000473:pathology; D000368:Aged; D000936:Antigen-Antibody Complex / Q000032:analysis; D001021:Aortic Valve / Q000601:surgery; D004342:Drug Hypersensitivity / Q000150:complications* / Q000209:etiology; D005260:Female; D015726:Giant Cells / Q000473:pathology*; D050533:Glomerular Basement Membrane / Q000276:immunology*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007684:Kidney Tubules / Q000276:immunology / Q000473:pathology; D008297:Male; D009395:Nephritis, Interstitial / Q000150:complications* / Q000209:etiology / Q000276:immunology / Q000473:pathology; D012214:Rheumatic Heart Disease / Q000188:drug therapy / Q000601:surgery; D013997:Time Factors
D000936:Antigen-Antibody Complex