title: Effective Treatment With Everolimus for Recurrent Granulomatous Interstitial Nephritis in a Renal Transplant Recipient: A Case Report.
abstract: BACKGROUND
  Granulomatous interstitial nephritis (GIN) is a rare renal disease, and its etiology remains unknown. We report recurrent GIN in renal allograft successfully treated with everolimus (EVR).
  
  
  METHODS
  A 22-year-old man with GIN received a kidney from his mother. On follow-up 8 months later, his serum creatinine level was increased, from 1.3 mg/dL to 1.7 mg/dL, and he had microhematuria and proteinuria. A protocol graft biopsy at 1 year after transplantation showed epithelioid granuloma with multinucleated giant cells. He received steroid pulse therapy for recurrent GIN twice, but he developed allograft dysfunction, hematuria, and proteinuria. EVR was started in combination with maintenance immunosuppressants at 28 months after transplantation. Thereafter, the serum creatinine level decreased, from 2.1 mg/dL to 1.6 mg/dL, and microhematuria and proteinuria were stable despite reduction of steroid dose.
  
  
  CONCLUSIONS
  Maintenance immunosuppressive therapy combined with EVR may be effective for the recurrence of idiopathic GIN in renal allograft.
authors.affiliation: Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Kanagawa, Japan. Electronic address: jtreran@yokohama-cu.ac.jp.
authors.forename: J
authors.initials: J
authors.lastname: Teranishi
authors.affiliation: Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Kanagawa, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Hattori
authors.affiliation: Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Kanagawa, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Mochizuki
authors.affiliation: Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Kanagawa, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Kawahara
authors.affiliation: Department of Urology, Yokohama City University Graduate School of Medicine, Kanagawa, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Makiyama
authors.affiliation: Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Kanagawa, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Uemura
mesh_terms: D001706:Biopsy; D000068338:Everolimus / Q000627:therapeutic use*; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007668:Kidney / Q000473:pathology; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D009395:Nephritis, Interstitial / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D012008:Recurrence; D066027:Transplant Recipients; D014184:Transplantation, Homologous / Q000009:adverse effects; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D000068338:Everolimus