Allergic Interstitial Nephritis Manifesting as a Striated Nephrogram
Allergic interstitial nephritis (AIN) is an underdiagnosed cause of acute kidney injury (AKI). Guidelines suggest that AIN should be suspected in a patient who presents with an elevated serum creatinine and a urinalysis that shows white cells, white cell casts, or eosinophiluria. Drug-induced AIN is...
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| Format: | Article |
| Language: | English |
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Wiley
2015-01-01
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| Series: | Case Reports in Medicine |
| Online Access: | http://dx.doi.org/10.1155/2015/250530 |
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| author | Irfan Moinuddin Erika Bracamonte Bijin Thajudeen Amy Sussman Machaiah Madhrira James Costello |
| author_facet | Irfan Moinuddin Erika Bracamonte Bijin Thajudeen Amy Sussman Machaiah Madhrira James Costello |
| author_sort | Irfan Moinuddin |
| collection | DOAJ |
| description | Allergic interstitial nephritis (AIN) is an underdiagnosed cause of acute kidney injury (AKI). Guidelines suggest that AIN should be suspected in a patient who presents with an elevated serum creatinine and a urinalysis that shows white cells, white cell casts, or eosinophiluria. Drug-induced AIN is suspected if AKI is temporally related to the initiation of a new drug. However, patients with bland sediment and normal urinalysis can also have AIN. Currently, a definitive diagnosis of AIN is made by renal biopsy which is invasive and fraught with risks such as bleeding, infection, and hematoma. Additionally, it is frequently unclear when a kidney biopsy should be undertaken. We describe a biopsy proven case of allergic interstitial nephritis which manifested on contrast enhanced Magnetic Resonance Imaging (MRI) as a striated nephrogram. Newer and more stable macrocyclic gadolinium contrast agents have a well-demonstrated safety profile. Additionally, in the presentation of AKI, gadolinium contrast agents are safe to administer in patients who demonstrate good urine output and a downtrending creatinine. We propose that the differential for a striated nephrogram may include AIN. In cases in which the suspicion for AIN is high, this diagnostic consideration may be further characterized by contrast enhanced MRI. |
| format | Article |
| id | doaj-art-22bccfee91584c108e621731dfa3caf1 |
| institution | Kabale University |
| issn | 1687-9627 1687-9635 |
| language | English |
| publishDate | 2015-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Medicine |
| spelling | doaj-art-22bccfee91584c108e621731dfa3caf12025-02-03T07:25:19ZengWileyCase Reports in Medicine1687-96271687-96352015-01-01201510.1155/2015/250530250530Allergic Interstitial Nephritis Manifesting as a Striated NephrogramIrfan Moinuddin0Erika Bracamonte1Bijin Thajudeen2Amy Sussman3Machaiah Madhrira4James Costello5Division of Nephrology, University of Arizona Medical Center, Tucson, AZ 85724, USADepartment of Pathology, University of Arizona Medical Center, Tucson, AZ 85724, USADivision of Nephrology, University of Arizona Medical Center, Tucson, AZ 85724, USADivision of Nephrology, University of Arizona Medical Center, Tucson, AZ 85724, USADivision of Nephrology, University of Arizona Medical Center, Tucson, AZ 85724, USADepartment of Medical Imaging, University of Arizona Medical Center, Tucson, AZ 85724, USAAllergic interstitial nephritis (AIN) is an underdiagnosed cause of acute kidney injury (AKI). Guidelines suggest that AIN should be suspected in a patient who presents with an elevated serum creatinine and a urinalysis that shows white cells, white cell casts, or eosinophiluria. Drug-induced AIN is suspected if AKI is temporally related to the initiation of a new drug. However, patients with bland sediment and normal urinalysis can also have AIN. Currently, a definitive diagnosis of AIN is made by renal biopsy which is invasive and fraught with risks such as bleeding, infection, and hematoma. Additionally, it is frequently unclear when a kidney biopsy should be undertaken. We describe a biopsy proven case of allergic interstitial nephritis which manifested on contrast enhanced Magnetic Resonance Imaging (MRI) as a striated nephrogram. Newer and more stable macrocyclic gadolinium contrast agents have a well-demonstrated safety profile. Additionally, in the presentation of AKI, gadolinium contrast agents are safe to administer in patients who demonstrate good urine output and a downtrending creatinine. We propose that the differential for a striated nephrogram may include AIN. In cases in which the suspicion for AIN is high, this diagnostic consideration may be further characterized by contrast enhanced MRI.http://dx.doi.org/10.1155/2015/250530 |
| spellingShingle | Irfan Moinuddin Erika Bracamonte Bijin Thajudeen Amy Sussman Machaiah Madhrira James Costello Allergic Interstitial Nephritis Manifesting as a Striated Nephrogram Case Reports in Medicine |
| title | Allergic Interstitial Nephritis Manifesting as a Striated Nephrogram |
| title_full | Allergic Interstitial Nephritis Manifesting as a Striated Nephrogram |
| title_fullStr | Allergic Interstitial Nephritis Manifesting as a Striated Nephrogram |
| title_full_unstemmed | Allergic Interstitial Nephritis Manifesting as a Striated Nephrogram |
| title_short | Allergic Interstitial Nephritis Manifesting as a Striated Nephrogram |
| title_sort | allergic interstitial nephritis manifesting as a striated nephrogram |
| url | http://dx.doi.org/10.1155/2015/250530 |
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