Abstract
A six-year-old girl was admitted to our hospital with acute renal failure. We made a clinical diagnosis of acute interstitial nephritis and oral corticosteroid therapy was started. Her renal failure soon recovered, and renal biopsy showed acute interstitial nephritis by light microscopy with glomerular foot process effacement by electron microscopy. Although her proteinuria was not heavy at the time of biopsy, her proteinuria subsequently increased to show nephrotic syndrome. We continued to give corticosteroids and her nephrotic syndrome went into remission 13 days after biopsy. Serological and bacteriological examination showed no evidence of known pathogen or drug hypersensitivity. The time changes in proteinuria were monitored by fractional total protein excretion (FETP) and fractional β2 microglobulin excretion (FEβ2MG) in order to evaluate the severity of proteinuria under different glomerular filtration rates and different proximal tubular functions. The results revealed that nephrotic syndrome had occurred during recovery from acute interstitial nephritis. This is the first case report to show the sequential occurrence of acute interstitial nephritis and nephrotic syndrome based on evidence from fractional protein excretion.
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References
Shwayder M, Ozawa T, Boedecker E, Guggenheim S, McIntosh RM (1976) Nephrotic syndrome associated with Fanconi Syndrome. Immunopathogenic studies of tubulointerstitial nephritis with autologous immune-complex glomerulonephritis. Ann Intern Med 84:433–437
Bander SJ (1985) Reversible renal failure and nephrotic syndrome without interstitial nephritis from zomepirac. Am J Kidney Dis 6:233–236
Porile JL, Bakris GL, Garella S (1990) Acute interstitial nephritis with glomerulopathy due to nonsteroidal anti-inflammatory agents: a review of its clinical spectrum and effects of steroid therapy. J Clin Pharmacol 30:468–475
Dharnidharka VR, Rosen S, Somers MJ (1998) Acute interstitial nephritis presenting as presumed minimal change nephrotic syndrome. Pediatr Nephrol 12:576–578
Lantz B, Cochat P, Bouchet JL, Fischbach M (1994) Short-term niflumic-acid-induced acute renal failure in children. Nephrol Dial Transplant 9:1234–1239
Portman RJ, Kissane JM, Robson AM (1986) Use of beta 2 microglobulin to diagnose tubulo-interstitial renal lesions in children. Kidney Int 30:91–98
Tomlinson PA, Dalton RN, Turner C, Chantler C (1990) Measurement of beta 2-microglobulin, retinol-binding protein, alpha 1-microglobulin and urine protein 1 in healthy children using enzyme-linked immunosorbent assay. Clin Chim Acta 192:99–106
Ellis D, Fried WA, Yunis EJ, Blau EB (1981) Acute interstitial nephritis in children: a report of 13 cases and review of the literature. Pediatrics 67:862–870
Alper AB Jr, Meleg-Smith S, Krane NK (2002) Nephrotic syndrome and interstitial nephritis associated with celecoxib. Am J Kidney Dis 40:1086-1090
Nortier J, Depierreux M, Bourgeois V, Ducobu J, Dupont P (1991) Progression of a naproxen and amoxicillin induced acute interstitial nephritis with nephrotic syndrome: case report. Clin Nephrol 35:187–189
Neugarten J, Gallo GR, Baldwin DS (1983) Rifampin-induced nephrotic syndrome and acute interstitial nephritis. Am J Nephrol 3:38–42
Deray G, Baumelou A, Beaufils H, Jacobs C (1990) Drug-induced interstitial nephropathy with nephrotic syndrome. Presse Med 19:1985–1988
Wirta O, Pasternack A, Mustonen J, Oksa H, Koivula T, Helin H (1995) Albumin excretion rate and its relation to kidney disease in non-insulin-dependent diabetes mellitus. J Intern Med 237:367–373
Agarwal N, Phadke KD, Garg I, Alexander P (2003) Acute renal failure in children with idiopathic nephrotic syndrome. Pediatr Nephrol 18:1289–1292
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Takahashi, S., Kitamura, T., Murakami, H. et al. Acute interstitial nephritis predisposed a six-year-old girl to minimal change nephrotic syndrome. Pediatr Nephrol 20, 1168–1170 (2005). https://doi.org/10.1007/s00467-005-1873-1
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DOI: https://doi.org/10.1007/s00467-005-1873-1