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CASE REPORT
Granulomatous interstitial nephritis: a rare diagnosis with an overlooked culprit
  1. Ana Carolina Figueiredo1,
  2. Luís Rodrigues1,2,
  3. Vítor Sousa3,4 and
  4. Rui Alves1,5
  1. 1 Nephrology Department, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
  2. 2 Universidade de Coimbra Faculdade de Medicina, Coimbra, Portugal
  3. 3 Anatomical Pathology Department, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
  4. 4 Coimbra’s Medical College, Coimbra, Portugal
  5. 5 Nephrology Universitary Clinic, Universidade de Coimbra Faculdade de Medicina, Coimbra, Portugal
  1. Correspondence to Dr Ana Carolina Figueiredo, carolinarfigueiredo{at}gmail.com

Abstract

Granulomatous interstitial nephritis (GIN) is a rare entity identified in <1% of native kidney biopsies. The most frequent aetiology is drug-related, followed by systemic granulomatous conditions. Among drugs implicated in GIN, antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs) are the most frequent. We report the case of a 45-year-old white man referred to a nephrology consult due to chronic kidney disease. He had a history of arterial hypertension with 10 years of evolution, hyperuricaemia, medicated with allopurinol and NSAID abuse for at least 20 years. Urine sediment was blunt, without proteinuria. Renal ultrasound was normal. A kidney biopsy revealed well-defined epithelioid granulomas with glomerular wrinkling and collapse. Infectious and systemic conditions were excluded, favouring the hypothesis of drug-induced GIN, probably related to NSAIDs. Kidney biopsy remains the gold standard for the diagnosis of GIN. Facing a patient with renal failure without significant proteinuria or active sediment, one should look for causes of tubulointerstitial injury.

  • renal system
  • chronic renal failure
  • contraindications and precautions
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Footnotes

  • Contributors All the authors have contributed in the presented clinical case and in the revision of the article. ACF has contributed in patient follow-up and etiological study, background investigation, acquisition of clinical and laboratory data and description of the clinical case. LR has contributed in observation of the kidney biopsy, correlation between histological and clinical findings and article revision. VS has contributed in observation of the kidney biopsy and description of histological findings. RA has contributed in the revision of the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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