Rabeprazole induced acute interstitial nephritis

A 84-year-old women underwent renal biopsy because of rapidly progressive renal failure. Rabeprazole induced interstitial nephritis was diagnosed. Interstitial nephritis may complicate the course of any proton pump inhibitor treatment. It is a rare and serious complication. Clinician's awareness of this adverse event is essential for early diagnosis and prompt recovery.     

Morphine increases susceptibility to oral Salmonella typhimurium infection

This study examined the effect of morphine on oral infection with virulent Salmonella typhimurium. Animals were treated with a 75-mg slow-release morphine pellet followed by inoculation with salmonellae. Morphine markedly sensitized mice to oral infection, as assessed by survival, mean survival time, and colony culture. By 24 h after Salmonella inoculation, morphine-treated mice had a 105-fold difference in number of organisms in the Peyer's patches, compared with controls. The opioid antagonist naltrexone significantly blocked Salmonella colonization in Peyer's patches and reduced Salmonella burden in other organs, indicating that morphine acts at least in part via an opioid receptor-mediated pathway. The data show that morphine markedly potentiates Salmonella infection at the gastrointestinal portal of entry and enhances subsequent dissemination of Salmonella organisms. The results have implications for potentiating gastrointestinal opportunistic infections in intravenous drug abusers and in opioid-medicated postsurgical patients.     

Reversible renal glycosuria in acute interstitial nephritis

ABSTRACT:: Renal glycosuria is defined as the excretion of glucose in urine in a normoglycemic state. It results from renal tubular dysfunction or immaturity of tubular function in the newborn. Etiologically, renal glycosuria is of 3 types-benign renal glycosuria, glycosuria with diabetes mellitus (including gestational diabetes) and tubular defects (Fanconi syndrome). Prognosis of benign renal glycosuria is excellent and reversible. Acute interstitial nephritis (AIN) is one of the main causes of acute renal failure and may often result in tubular dysfunction. In this study, the authors report the occurrence of AIN with acute renal failure that contributed to reversible renal glycosuria. The glycosuria observed in the patient of this study was an isolated tubular defect, with no phosphaturia, aminoaciduria or bicarbonaturia. Such a presentation is very rare in adults and has not been previously reported. These findings confirm that AIN with acute renal failure can cause an isolated tubular defect with benign reversible glycosuria in an adult.     

Vancomycin-induced acute granulomatous interstitial nephritis: therapeutic options

Drug-induced acute renal failure is a commonly encountered mode of renal injury in the hospitalized patient. Vancomycin is a frequently used antibiotic in patients with Gram-positive bacterial infections. In the present study, we evaluated an index case of a patient who developed severe acute granulomatous interstitial nephritis and provided a review of the reported cases of vancomycin-induced acute renal failure in the literature. A Medline search revealed a total of 11 cases of vancomycin-induced interstitial nephritis. In 2 reported cases, interstitial nephritis has been reported with associated granuloma formation. However, the role of T cells in the formation of interstitial nephritis and in the choice of therapeutic modalities in this scenario has not been evaluated in the past. In the index case, we have evaluated the effect of treatment on the basis of the type of cellular infiltrates and provided a follow-up by carrying out the repeat biopsy.     

Genetics of resistance to infection with Salmonella typhimurium in mice.

Eight strains of inbred mice fell into two sharply defined groups. Four strains (CBA, A/JAX, C3H/He, and DBA/2) were resistant (LD50, greater than 10(5)) to Salmonella typhimurium C5 given subcutaneously. The other four strains (Balb/c, C57BL, B10.D2 [new line], and DBA/1) were susceptible (LD50, less than 10). No intermediate resistance was seen. Examination of the F1, F2, and parental backcross generations bred from matings of CBA and Balb/c mice showed that resistance behaved as a simple Mendelian dominant. Resistance was not linked to H-2 genes, and no useful marker has yet been found. However, as previously demonstrated in the parent strains, resistance in the hybrids was related to the ability to produce a good delayed-type hypersensitivity reaction to an extract of S. typhimurium.     

Acute tubulo-interstitial nephritis leading to acute renal failure following multiple hornet stings

Background

Cisplatin is a well-known nephrotoxic antineoplastic drug. Chronic hypokalemic metabolic alkalosis with hypomagnesemia and hypocalciuria is one of the rare complications associated with its use.

Case presentation

A 42- year-old woman presented with a 20 year-history of hypokalemic metabolic alkalosis with hypomagnesemia and hypocalciuria after cisplatin-based chemotherapy for ovarian cancer. This patient has had chronic muscle aches and fatigue and has had episodic seizure-like activity and periodic paralysis. Only thirteen other patients with similar electrolyte abnormalities have been described in the literature. This case has the longest follow-up.

Conclusion

Cisplatin can cause permanent nephrotoxicity, including Gitelman-like syndrome. This drug should be considered among the possible causes of chronic unexplained electrolyte disorders.     

Biopsy proven acute interstitial nephritis after treatment with moxifloxacin

Background

Acute interstitial nephritis (AIN) is an important cause of reversible acute kidney injury. At least 70% of AIN is caused by various drugs, mainly penicillines and non-steroidal anti-inflammatory drugs. Quinolones are only rarely known to cause AIN and so far cases have been mainly described with older fluoroquinolones.

Case Presentation

Here we describe a case of biopsy proven interstitial nephritis after moxifloxacin treatment. The patient presented with fever, rigors and dialysis dependent acute kidney injury, just a few days after treatment of a respiratory tract infection with moxifloxacin. The renal biopsy revealed dense infiltrates mainly composed of eosinophils and severe interstitial edema. A course of oral prednisolone (1 mg/kg/day) was commenced and rapidly tapered to zero within three weeks. The renal function improved, and the patient was discharged with a creatinine of 107 μmol/l.

Conclusion

This case illustrates that pharmacovigilance is important to early detect rare side effects, such as AIN, even in drugs with a favourable risk/benefit ratio such as moxifloxacin.     

Delayed renal function recovery from drug-induced acute interstitial nephritis

IntroductionAcute interstitial nephritis, considered one of the major causes of reversible acute kidney injury, was frequently encountered as drug-treatment complication in the early stage of infection control. In some cases, drug-induced acute interstitial nephritis (DIAIN) resulted in delayed function recovery or chronic kidney disease. To study the underlying mechanism, the authors investigated the clinical and pathological features of DIAIN patients with delayed renal function recovery. The delayed recovery group consisted of patients with reduced renal function for more than 3 months after diagnosis.MethodsIn this retrospective study, 18 patients with DIAIN from January 2003 to December 2009 were identified as the delayed recovery group, whereas 54 patients with DIAIN who recovered completely within 3 months were treated as the control group. Clinical and pathological features were compared between the 2 groups.ResultsIn the delayed recovery group, the average age at onset was 48.8 years, antibiotics and herbs were the 2 main causative drugs and the dominant extra-renal manifestation was gastrointestinal symptomatology. In comparison with patients in the control group, patients in the delayed recovery group had longer interval time from disease onset to hospitalization, and they presented with less oliguria. Moreover, these patients had higher levels of urine retinol binding protein, and more renal interstitial inflammatory cell infiltrations were observed in their renal histology.ConclusionAging, long interval time from disease onset to hospitalization and renal interstitial inflammatory cell infiltration may predict delayed renal function recovery.