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- Title
Severe acute interstitial nephritis: Response to therapy with anti-thymocyte globulin.
- Authors
Shao, Tiffany; Weinstein, Jordan; Goldstein, Marc; Jothy, Serge
- Abstract
Objective: To evaluate the potential effect of thymoglobulin therapy on the histopathology and clinical course of acute interstitial nephritis (AIN). Method(s): Immunofluorescence and immunohistochemistry. Data and results: A 43-year-old female presented with acute kidney injury and a serum creatinine of 1170 umol/L in July 2014. Her renal biopsy showed acute interstitial nephritis (AIN) with a predominately lymphocytic infiltrate and no apparent etiology. Despite corticosteroid therapy and subsequent addition of mycophenolate mofetil, she remained dialysis dependant. As a repeat biopsy in November 2014 showed similar findings of AIN she was admitted for thymoglobulin infusions and she came off hemodialysis 2 months later. A third renal biopsy 16 months after the infusions showed a lower density, patchy infiltrate of lymphocytes in the interstitium, and her creatinine has remained in the stable 140 umol/L range. Subsequent to thymoglobulin treatment, there was a marked and parallel decrease in the renal density of T lymphocytes, both T helper and T suppressor cells, and also monocytes/macrophages. Immunohistochemical characterization demonstrated that before and after treatment, the means of T-lymphocytes (identified by CD3 marker) in the renal cortex were 3853+/-436 and 663 +/- 184 per unit area (P<0.0005), respectively. Conclusions: Thymoglobulin is a potentially useful new treatment for interstitial nephritis. We report here a single case of partial response to thymoglobulin, however we need to also take into consideration the side effects of thymoglobulin including lymphopenia, which are occasionally observed in the treatment of acute cellular rejection of kidney allografts. To conclude, the present report is the first to show partial response of thymoglobulin therapy in a patient with acute interstitial nephritis.
- Subjects
INTERSTITIAL nephritis; THYMOCYTES; IMMUNOFLUORESCENCE; IMMUNOHISTOCHEMISTRY; T cells
- Publication
Canadian Journal of Pathology, 2017, Vol 9, p24
- ISSN
1918-915X
- Publication type
Article