ABSTRACT
PURPOSE: Granulomatous interstitial nephritis (GIN) are identified in 0.5 to 1,3% of all renal biopsies. Renal outcome and treatment modalities are not clearly established in the literature. METHODS: We retrospectively analyzed a case series of 44 GIN identified among all renal biopsies performed between 1984 and 2005 in the Rhône-Alpes area. RESULTS: The study population included 25 men and 19 women with a mean age of 56 years, and mean diagnostic delay was 11 months. Renal function was severely impaired (mean creatinine clearance 24mL/min). Proteinuria was observed in 77% (mean value 0,9 g/24h) of the patients and associated with microscopic hematuria and leukocyturia in 30% and 25%, respectively. The most common diagnosis was sarcoidosis (25%, n = 11), followed by drug-induced GIN (9%, n = 4), tuberculosis (6,8%, n=3), hemopathy-related paraneoplastic GIN (6,8%, n = 3), HIV infection (n = 1) and chronic renal allograft rejection (n = 1). In other patients, no aetiology was found (48%, n = 21). Severity of renal failure justified hemodialysis in 34% (n = 15) of the patients. Three patients underwent renal transplantation. Nonetheless, renal outcome was generally favorable: renal function improved in 41% (n = 18) and stabilized in 34% (n = 15) of patients. CONCLUSIONS: Sarcoidosis, drug-induced and infections represent the main causes of GIN. Histologic features are not specific enough to determine the aetiology. Corticosteroids is the gold standard in sarcoidosis, drug-induced, and idiopathic GIN. Treatment is etiologic in the other cases.
Subject(s)
Nephritis, Interstitial , Female , Granuloma/diagnosis , Granuloma/therapy , Humans , Male , Middle Aged , Nephritis, Interstitial/diagnosis , Nephritis, Interstitial/etiology , Nephritis, Interstitial/therapy , Retrospective StudiesABSTRACT
BACKGROUND: Anaesthetic preconditioning, i.e. administration of volatile agents before ischemia, is known to have protective effects on several organs, but remains uncertain on the kidney. We developed a rabbit model for acute ischaemia-reperfusion injury, and examined a possible protective effect of desflurane preconditioning on the kidney. METHODS: Forty New Zealand male rabbits, 3 months old, weighing 2-3 kg, were anaesthetized by titrated intramuscular injections of xylazine-ketamine, mechanically ventilated and monitored. They were randomly assigned into four groups: group ischaemia (I), group ischaemic preconditioning (IPC), group desflurane preconditioning (DPC), and group SHAM (S). Groups I, IPC and DPC were subjected to 45 minutes of bilateral renal ischaemia followed by 3 hours reperfusion. Group IPC was subjected to 3 x 3 minutes ischaemia, 5 minutes before the 45-minute clamping period. Group DPC was administered one MAC desflurane for 30 minutes, before a 30-minute wash-out period. Histological analysis of the cortical zone of both kidneys were blindly performed. Tubular cell damage was graded from 1 (no lesion) to 4 (>50 % cell necrosis). Pycnotic nuclei and intratubular hyaline casts were counted on each section. RESULTS: DPC (1[1-2]) and S (1[1-1]) groups displayed lower histological grades than group 1(4[3-4]) (p<0.01); IPC had a grade of 3 (2-3), I and IPC groups had higher scores of pycnotic nuclei and hyaline casts than DPC and S. CONCLUSION: Desflurane preconditioning was associated with a diminution of tubular cell damage. Ischaemic preconditioning did not show a significant renal protective effect.
Subject(s)
Acute Kidney Injury/prevention & control , Anesthetics, Inhalation/therapeutic use , Ischemic Preconditioning, Myocardial/methods , Isoflurane/analogs & derivatives , Reperfusion Injury/prevention & control , Acute Kidney Injury/pathology , Anesthesia , Anesthetics, Dissociative , Animals , Blood Pressure/drug effects , Carbon Dioxide/blood , Desflurane , Heart Rate/drug effects , Isoflurane/therapeutic use , Ketamine , Kidney/pathology , Male , Rabbits , Reperfusion Injury/pathology , Respiration, ArtificialABSTRACT
Renal involvement is an unusual complication of human visceral leishmaniasis (VL). The kidney lesions are characterized more by interstitial damage than glomerular or vascular damage. This case represents a 20 years-old man admitted with pancytopenia, purpura, acute renal failure, and nephrotic syndrome associated with heavy proteinuria. The diagnosis of VL was made on bone marrow smear cytology where Leishmania amastigotes were found. The renal biopsy revealed a segmental necrotising glomerulonephritis with 70% crescents. Treatment with liposomal amphotericine B alone has been ineffective on the course of renal failure, however, partial recovery was obtained after the administration of high dose corticosteroids. We present the various clinical, biological, and histological aspects of this case, from the south of France. It gave us the opportunity to discuss these unusual manifestations of immunomediated necrotising skin and renal lesions.