Severe acute kidney injury due to oxalate crystal induced severe interstitial nephritis:A case report

BACKGROUND Acute kidney injury(AKI)due to interstitial nephritis is a known condition primarily attributed to various medications.While medication-induced interstitial nephritis is common,occurrences due to non-pharmacological factors are rare.This report presents a case of severe AKI triggered by intratubular oxalate crystal deposition,leading to interstitial nephritis.The aim is to outline the case and its management,emphasizing the significance of recognizing uncommon causes of interstitial nephritis.CASE SUMMARY A 71-year-old female presented with stroke-like symptoms,including weakness,speech difficulties,and cognitive impairment.Chronic hypertension had been managed with hydrochlorothiazide(HCTZ)for over two decades.Upon admis-sion,severe hypokalemia and AKI were noted,prompting discontinuation of HCTZ and initiation of prednisolone for acute interstitial nephritis.Further investigations,including kidney biopsy,confirmed severe acute interstitial nephritis with oxalate crystal deposits as the underlying cause.Despite treatment,initial renal function showed minimal improvement.However,with prednisolone therapy and supportive measures,her condition gradually improved,high-lighting the importance of comprehensive management.CONCLUSION This case underscores the importance of a thorough diagnostic approach in identifying and addressing uncommon causes of interstitial nephritis.The occurrence of interstitial nephritis due to oxalate crystal deposition,especially without typical risk factors,emphasizes the need for vigilance in clinical practice.

Reversible Chronic Interstitial Nephritis Induced by Tacrolimus —Tacrolimus Chronic Interstitial Nephritis

Calcineurin inhibitors (CNI) are potent immunosuppressive agents in prophylaxis against graft rejection and autoimmune diseases including primary glomerulopathies. Previous research showed reversible;acute afferent arteriolar vasculopathy and irreversible chronic interstitial fibrosis associated with CNI nephrotoxicity. In this case report we describe a patient, with minimal change disease, that had developed chronic and progressive renal disease while receiving therapeutic dose of Tacrolimus. His serum creatinine had reached 537 umol/L and his nephrotic state worsened. Kidney biopsy showed chronic interstitial nephritis. Tacrolimus was discontinued and he was treated with 1 mg/kg prednisone in addition to Mycophenolate mofetil (MMF) 1 g twice daily. By the 2nd month;serum creatinine returned to normal and by the 3rd month serum albumin too. After 1 month of therapy;the dose of Prednisone was tapered down gradually till 5 mg daily by the end of 3rd month. Moreover, the dose of MMF was reduced to 500 mg X2 by the end of 3rd month. After 2 years of follow up;he remained stable and without relapse of NS or renal failure. In conclusion, reversible renal disease, due to chronic interstitial nephritis can be induced by CNI which is amenable to treatment with Prednisone and MMF.

A Case of Staphylococcus Associated Glomerulonephritis Confused with Acute Interstitial Nephritis

Staphylococcus associated glomerulonephritis (SAGN) is an uncommon infection-related glomerulonephritis. Although infection is typically ongoing when patients present with SAGN, in the case of deep-seated infections, the presence of infection may not be apparent. The aim of this study is to highlight the importance of renal biopsy when the diagnosis is not obvious. We present a case of staphylococcus associated glomerulonephritis in a patient treated with beta-lactam antibiotics for staphylococcus bacteraemia. A renal biopsy helped differentiate between interstitial nephritis and staphylococcus associated glomerulonephritis.

Fabry disease combined with acute interstitial nephritis:one case and literature review

Objective:To explore the clinical and pathological features of Fabry disease complication of acute interstitial nephritis.Methods:A retrospective analysis of a patient with Fabry disease and acute interstitial nephritis diagnosed and in the Department of Nephrology,Children’s Hospital Affiliated to Capital Institute of Pediatrics in January 2017 was performed.A literature search was performed with“Fabry disease,acute interstitial nephritis”as the keywords in Wanfang database and PubMeds database.Result:The patient was 10-years-old with acute renal dysfunction.Electron microscopy showed stratified myelin-like bodies,zebra bodies and fused foot segment.The patient was finally diagnosed with the combination of Fabry disease and acute interstitial nephritis.By now,such cases have been reported.Conclusion:Whether Fabry's disease and acute interstitial nephritis shared the common pathogenic mechanism is unclear.Early renal biopsy is important for the diagnosis of this disease.

15.4.Interstitial nephritis and interstitial nephropathy

920356 Correlation of levels of IgE and IL-4in INS patients.YAO Zhi (姚智),et al.DeptImmunol,Beijing Med Univ,100083.Chin Jimmunol 1992;8(1):48-49.

Interstitial nephritis and interstitial nephropathy

930568 The production and significance of IL4in patients with idiopathic nephroctic syndrome.YAO Zhi(姚智),et al.Dept Immunol,BeijingMed Univ,Beijing,100083,Natl Med J China1993;73(5):261—263.Samples of serum and PBMC were collected atthe same time from 42 pediatric patients with id-iopathic nephrotic syndrome(INS)and 28 age—matched healthy individuals.The level os IgE inserum was detected and IL4 in supernatant ofPHA-activated PBMC assayed by sandwichELISA.The levels of IL4 and IgE in healthy in-dividuals were 400～500 pg/ml and 50～100 U/ml respectively,and those of IL and IgE in theINS patients were on the average 1080～4000Pg/ml and 380～1000 U/ml.Positive correla-

Interstitial nephritis and interstitial nephropathy

970370 The expression of AT1A receptor and itsmodulation by benazepril in the renal tubulointerstitiallesions induced by ureteral obstruction. CHEN Xi-angmei(陈香美), et al. Nephrol Div, General Hosp,PLA, Beijing, 100853. Natl Med J China 1997; 77(4):245-248.

15.4.Interstitial nephritis and interstitial nephropathy

920149 The relationship between renal tis-sue subsets of lymphocytes and clinicalfeatures in IgA nephropathy.LIU Zhihong （刘志红）,et al.Dept Nephrol,Jinling Hosp,Nanjing（210002）.Chin J Nephrol 1991; 7 （4）: 230.Amount of CD4+,CD8+ and B cells in

Interstitial nephritis and interstitial nephropathy

920710 A study of the cytomegalovirus-DNA in serum and renal tissue of patients-with IgA nephropathy. LIU Zhihong(刘志红),et al. Dept Nephrol, Jinling Hosp,Nanjing,210002. Nail Med J China 1992; 72(4): 198-200. Cytomegalovirus (CMV) has been suspectedto be involved in the pathogenesis of IgA nep-

Interstitial nephritis and interstitial nephropathy

950358 Detection of glucocorticoid receptor (GCR)of lymphocyte in childnephrotic syndrome (NS).TANG Jieru(汤洁如),et al.Dept Pediatr,1st AffiliHosp,Sun Yat-sen Meal Univ,Guangzhou.Chin JNephrol 1994;10(6):342-343.Assesment of steroid receptor content in humanneoplastic cells or mammary tumor cells has been pre-viously used to prearct steriod sensitivity in variouscancers.In the present study,we evaluated the rela-tionship between GCR content and the prednisone sen-

15.4.Interstitial nephritis and interstitial nephropathy

930331 Significance of determination of urinealbumin for early diagnosis of diabeticnephropathy.ZHOU Zhongyuan (周中源),Shanghai 4th People’s Hosp.Shanghai Med J1993;16(2):74—76.The results of urine albumin determination in208 patients with non-insulin dependent dia-betes mellitus but tested negative for urinaryprotein on routine examination and in 177 nor-mal controls were reported.The results showedthat the excretion of urine albumin in 131 pa-tients was obviously higher than that in normalcontrols (p【0.001).In the diabetic patientstested negative for urinary protein on routineexamination the excretion of urine albumin

Monocyte chemoattractant protein 1 expression in renal tissue is associated w ith monocyte recruitment and tubulo-interstitial lesions in patients with lup us nephritis

Objective To investigate the pattern of monocyte chemoattractant prolein-1 (MCP-1) distribution in the renal interstitium and evaluate its pathogenic role in tubulo-interstitial lesions in patients with lupus nephritis, the distribution of MCP-1 in renal tissue was observed.Methods Eighteen female patients with biopsy-proven lupus nephritis were enrolled in this study. No intensive immunosuppresive therapy was used in these patients during the 3 months prior to renal biopsy. The distribution of MCP-1, infiltration of CD68+ (macrophage/monocyte), CD4+ and CD8+ cells in the tubulo-interstitium of patients with lupus nephritis was detected using immunohistochemical staining with specific antibodies. Renal specimens from patients with minimal change glomerulonephritis were used as controls. Results MCP-1 protein was widely distributed in the renal tissue of patients with lupus nephritis, mainly located at the baso-lateral surface of tubular epithelial cells (16/18 biopsies), and on the wall of interstitial blood vessels (9/18 biopsies). In contrast, tubular MCP-1 staining was weak and rare in renal tissue from controls (7.4±6.2% vs 26.7±22.8%, P<0.01). Tubulo-interstitial infiltration of CD68+, CD4+ and CD8+ cells was markedly increased in patients with lupus nephritis as compared to controls. The tubular expression of MCP-1 was strongly associated with the amount of CD68+ cell infiltration in the interstitium (r=0.5420, P<0.05) and the extent of interstitial fibrosis. There was no correlation between MCP-1 production in tubules and the degree of urinary protein excretion in patients with lupus nephritis (r=0.0547, P>0.05).Conclusions The expression of MCP-1 in the renal tubules and vascular wall was markedly increased in patients with lupus nephritis. The overproduction of MCP-1 in renal tissue may contribute to monocyte recruitment in the interstitium and thus result in tubulo-interstitial damage in lupus nephritis.

Trauma-related xanthogranulomatous interstitial nephritis: a clinicopathological analysis

Objective: To investigate the pathogenesis, exact nature, histologic feature of xanthogranulomatous interstitial nephritis (XGIN) as well as its significance in clinical medicine. Methods: The medical histories concerned were collected with diagnostic images including CT scanning, ultrasonography, intravenous urography (IVU) and laboratory data being synthesized by comparison with what was discovered during operations and pathologic examinations. Results: All patients were ever struck on their loins or backs by blunt violence over 4-12 years. The diseases were clinically diagnosed as “renal cancer” before, during and after operations, and treated with radical nephrectomy. Located at cortical parts, the tumor focus had penetrated the renal capsules and invaded other organs. However, immunohistochemistry demonstrated that the lesions were xanthogranulomas, not tumors, in which there were stacks of foam cells and lymphocytes with vast extends of fibrotic tissues obliterating the cortical interstitial structures. Urinary tracts yielded no bacterium, obstruction or calculus. Conclusions: XGIN is likely to be one kind of immunologic mediated granuloma following blunt renal trauma. It is imperative to clarify pathogenesis and character of this lesion so as to find out any approach to diagnosis and cure of such an unusual nephropathy.

Interstitial nephritis and interstitial nephropathy

2005238 Prospective clinic study of increasing doses of angiotensin converting enzyme inhibitor fosinopril in patients with mild proteinuria. CHEN Wei(陈崴), et al. Dept Nephrol 1st Affli Hosp, Sun Yat-sen U-niv, Guangzhou 510080. Chin J Nephrol, 2005; 21 (1):914. Objective: To evaluate the antiproteinuric effect of increasing doses of ACE inhibitor fosinopril in patients with mild proteinuria (1-3. 5g/24h), and in-

Interstitial nephritis and interstitial nephropathy

2009225 Effects of endoplasmic reticulum stress on albumin-induced apoptosis in renal proximal tubular cells.WU Xiaowei(吴小玮),et al.Dept Nephrol,Instit Surg,Daping Hosp,3rd Milit Med Univ,Chongqing 400042.Chin J Nephrol,2009;25(3):98-103.

Interstitial nephritis and interstitial nephropathy

2008325 ACTN4 gene variation and polymorphism in patients with primary focal segmental glomerulosclerosis.DAI Shengchuan(戴胜川),et al.Div Nephrol,Ruijin Hosp,Sch Med,Shanghai Jiaotong Univ,Shanghai 200025.Chin J Nephrol 2008;24(2):108-103.Objective To investigate the effects of variation and polymorphism of gene ACTN4 on primary focal segmental glomerulosclerosis(FSGS).Methods Eightytwo pa-tients with primary FSGS were enrolled in the study,

Interstitial nephritis and interstitial nephropathy

2008097 Effects of Smad7 on transdifferentiation and collagen Ⅰ synthesis in AGE-stimulated NRK52E cells. SUN Liao(孙辽), et al. Dept Nephrol, 1st Hosp Sun Yat-sen Univ, Guangzhou 510080. Chin J Endocrinol Metab 2007;23(6):544-548. Objective To investigate the effects of smad7 on transdifferentiation and collagen Ⅰ synthesis in advanced glycosylation end-products (AGE)-stimulated NRK52E cells. Methods NRK52E cells were transferred by pTet-on

Interstitial nephritis and interstitial nephropathy

2010365 Effect of fibrocytes on the progressive renal fibrosis induced by adriamycin.WANG Xian(王显),et al.Dept Nephrol, 1st Affil Hosp, Anhui Med Univ, Hefei 230022.Chin J Nephrol 2010;26(4):279-283. Objective To investigate, the effect of fibrocytes and chemokine receptor

Interstitial nephritis and interstitial nephropathy

2008467 Protective mechanism of NHE-1-siRNA on human renal tubular epithelial cell from ischemic reperfusion injury induced by antimycin A.HONG Quan(洪权), et al.Dept Nephrol, Kidney Center & Key Lab, PLA, General Hosp,PLA, Beijing 100853. Chin J Nephrol 2008;24(8):560 -565. Objective To explore the mechanism of protecting cells from ischemic reperfusion injury by constructing specific small interference RNA(siRNA) to