title: Non-steroidal anti-inflammatory drugs-associated acute interstitial nephritis with granular tubular basement membrane deposits.
abstract: Acute tubulo-interstitial nephritis (ATIN) is an important cause of acute renal failure resulting from a variety of insults, including immune complex-mediated tubulo-interstitial injury, but drugs such as non-steroidal anti-inflammatory drugs (NSAIDs) are a far more frequent cause. Overall, as an entity, ATIN remains under-diagnosed, as symptoms resolve spontaneously if the medication is stopped. We report on a 14-year-old boy who developed acute renal failure 2 weeks after aortic valve surgery. He was put on aspirin following surgery and took ibuprofen for fever for nearly a week prior to presentation. He then presented to the emergency department feeling quite ill and was found to have a blood urea nitrogen (BUN) concentration of of 147 mg/dl, creatinine of 15.3 mg/dl and serum potassium of 8.7 mEq/l. Dialysis was immediately initiated. A kidney biopsy showed inflammatory infiltrate consistent with ATIN. However, in the tubular basement membrane (TBM), very intense granular deposits of polyclonal IgG and C3 were noted. He needed dialysis for 2 weeks and was treated successfully with steroids for 6 months. His renal recovery and disappearance of proteinuria took a year. In conclusion, this is a first report of NSAIDs-associated ATIN, showing deposits of granular immune complex present only in the TBM and not in the glomeruli.
authors: Florida Children's Kidney Center, Department of Pediatrics, Florida Children's Hospital, 615 E. Princeton, Suite 500, Orlando, FL 32803, USA. Mehul.Dixit.MD@FLHosp.org
authors: Mehul P
authors: MP
authors: Dixit
authors: Cuong
authors: C
authors: Nguyen
authors: Thomas
authors: T
authors: Carson
authors: Ben
authors: B
authors: Guedes
authors: Naznin M
authors: NM
authors: Dixit
authors: Jane M
authors: JM
authors: Bell
authors: Yihan
authors: Y
authors: Wang
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D001241:Aspirin / Q000009:adverse effects; D001485:Basement Membrane / Q000473:pathology*; D006801:Humans; D007052:Ibuprofen / Q000009:adverse effects; D007684:Kidney Tubules / Q000473:pathology*; D008297:Male; D009395:Nephritis, Interstitial / Q000139:chemically induced* / Q000473:pathology
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin; D007052:Ibuprofen