Renal allograft granulomatous interstitial nephritis: observations of an uncommon injury pattern in 22 transplant recipients.

Authors:
Alton B Farris
Alton B Farris
Emory University
United States
Carla L Ellis
Carla L Ellis
The Johns Hopkins Hospital
Thomas E Rogers
Thomas E Rogers
Emory University
Atlanta | United States
Anthony Chang
Anthony Chang
University of Chicago
United States
Shane M Meehan
Shane M Meehan
University of Chicago
Chicago | United States

Clin Kidney J 2017 04 1;10(2):240-248. Epub 2017 Feb 1.

University of Chicago, Chicago, IL USA; Sharp Memorial Hospital, San Diego, CA, USA.

Granulomatous interstitial nephritis (GIN) is uncommon in native kidneys, and descriptions in allografts are few. We report clinical and pathologic findings in 22 allograft recipients with GIN identified in renal allograft biopsies and nephrectomies. Renal allografts with GIN were retrieved from the pathology files of two academic medical centers. Available clinical and pathologic data were compiled retrospectively for a 23-year period. GIN was present in 23 specimens from 22 patients (15 males and 7 females) with allograft dysfunction [serum creatinine averaged 3.3 mg/dL (range 1.4-7.8)], at a mean age of 48 years (range 22-77). GIN was identified in 0.3% of biopsies at a mean of 552 days post transplantation (range 10-5898). GIN was due to viral (5), bacterial (5) and fungal (2) infections in 12 (54.5%), and drug exposure was the likely cause in 5 cases (22.7%). One had recurrent granulomatosis with polyangiitis. In 4 cases, no firm etiology of GIN was established. Of 18 patients with follow up data, 33.3% had a complete response to therapy, 44.5% had a partial response and 22.2% developed graft loss due to fungal and infections. All responders had graft survival for more than 1 year after diagnosis of GIN. Allograft GIN is associated with a spectrum of etiologic agents and was identified in 0.3% of biopsies. Graft failure occurred in 22% of this series, due to fungal and bacterial GIN; however, most had complete or partial dysfunction reversal and long-term graft survival after appropriate therapy.

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http://dx.doi.org/10.1093/ckj/sfw117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5381240PMC

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April 2017
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(Supplied by CrossRef)
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Front Immunol 2013
Chemokines in innate and adaptive granuloma formation
Front Immunol 2013

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Am J Kidney Dis 2000
Granulomatous tubulointerstitial nephritis in a renal allograft: three cases report and review of literature
Clin Transplant 2012
Granulomatous interstitial nephritis in renal transplant recipient
J Med Assoc Thai 1996

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