title: Single-centre experience of granulomatous interstitial nephritis-time for a new approach?
abstract: Background:Differentiating between renal-limited sarcoidosis and tuberculosis (TB) infection as a cause of granulomatous interstitial nephritis (GIN) can be difficult. This series compares clinical features and response to treatment between the different underlying aetiologies in order to propose a management algorithm for GIN to assist with diagnosis and treatment.Methods:This retrospective study reports on all patients presenting with a histological diagnosis of GIN between 2000 and 2012 at our unit.Results:Twenty-one patients were identified, 57% were male and the mean age was 53 years. Eight cases were associated with sarcoidosis with evidence of extra-renal disease and five with renal-limited sarcoidosis. Five patients had GIN that may have been related to TB infection or to renal-limited sarcoidosis, and three were idiopathic or drug related. All those with sarcoidosis were treated with steroids and renal function, as measured by estimated glomerular filtration rate (eGFR), improved from a mean of 24 mL/min at baseline to 37 mL/min at 1 year. Baseline eGFR was 19 mL/min in those with possible TB infection. Four received steroids as well as anti-TB drugs. Anti-TB therapy was delayed in four patients by a mean of 22 months due to difficulties in diagnosis. Two patients with TB developed end-stage kidney disease and the remaining three patients had a mean eGFR of 28 mL/min at 1 year.Conclusions:This series represents the largest cohort of patients with GIN in the UK and supports previous findings that patients with sarcoid have a favourable outcome with steroid treatment. Those with TB have an inferior prognosis, perhaps due to delayed diagnosis. We suggest an algorithm when investigating a diagnosis of GIN with the aim of expediting diagnosis and considering a trial of anti-TB therapy in order to prevent deterioration of renal function.
authors.affiliation: Renal Unit, King's College Hospital, London, UK.
authors.forename: Ben
authors.initials: B
authors.lastname: Oliveira
authors.affiliation: Renal Unit, King's College Hospital, London, UK.
authors.forename: Satish
authors.initials: S
authors.lastname: Jayawardene
authors.affiliation: Renal Unit, King's College Hospital, London, UK.
authors.forename: Sapna
authors.initials: S
authors.lastname: Shah
keywords: chronic kidney disease; granulomatous; interstitial nephritis; sarcoidosis; tuberculosis