[Interstitial nephritis syndrome and uveitis]. 1991

L García de Cortázar, and C Alvarado, and J Las Heras
Servicio de Pediatría, Hospital Clínico San Borja, Arriarán.

A nine year old male patient was admitted to a metropolitan general hospital at Santiago, Chile, because of unexplained severe anemia (hematocrit 18%) and redness of the right eye. Uveitis was confirmed by ophthalmological examination. Laboratory work up showed an erythrocyte sedimentation rate of 101 mm.h, marked nitrogen retention (BUN 91 mg/dl), creatinine clearance was 9 ml/min.1,73 sq m, serum IgG and IgM immune globulin concentrations were 2,368 mg/dl and 263 mg/dl respectively, over the normal range for age, with almost absent serum IgA and reduced T cell populations. Negative rheumatoid factor, antinuclear antibodies and anti smooth muscle antibodies reactions were obtained, together with normal levels of C3 and C4 fractions of complement and normal urine sediment. Renal biopsy specimen included 25 glomerular, one of them was wholly sclerotic, another two had periglomerular fibrosis and the remainder showed only slightly increased mesangial matrix. Heavy mononuclear inflammatory interstitial infiltration, with granulomatous structures including giant multinuclear cells as those seen in foreign body reactions (fig 1) and PAS positive intraluminal tubular crystals were also observed. In spite of steroidal treatment, which was complicated by an inflammatory brain granuloma that healed in coincidence with parenteral antibiotic therapy, the patient evolved toward chronic renal failure. We think that the available evidence strongly suggests an immunological disorder as a very likely explanation for this case.

UI MeSH Term Description Entries
D007676 Kidney Failure, Chronic The end-stage of CHRONIC RENAL INSUFFICIENCY. It is characterized by the severe irreversible kidney damage (as measured by the level of PROTEINURIA) and the reduction in GLOMERULAR FILTRATION RATE to less than 15 ml per min (Kidney Foundation: Kidney Disease Outcome Quality Initiative, 2002). These patients generally require HEMODIALYSIS or KIDNEY TRANSPLANTATION. ESRD,End-Stage Renal Disease,Renal Disease, End-Stage,Renal Failure, Chronic,Renal Failure, End-Stage,Chronic Kidney Failure,End-Stage Kidney Disease,Chronic Renal Failure,Disease, End-Stage Kidney,Disease, End-Stage Renal,End Stage Kidney Disease,End Stage Renal Disease,End-Stage Renal Failure,Kidney Disease, End-Stage,Renal Disease, End Stage,Renal Failure, End Stage
D008297 Male Males
D009395 Nephritis, Interstitial Inflammation of the interstitial tissue of the kidney. This term is generally used for primary inflammation of KIDNEY TUBULES and/or surrounding interstitium. For primary inflammation of glomerular interstitium, see GLOMERULONEPHRITIS. Infiltration of the inflammatory cells into the interstitial compartment results in EDEMA, increased spaces between the tubules, and tubular renal dysfunction. Interstitial Nephritis,Nephritis, Tubulointerstitial,Tubulointerstitial Nephritis,Interstitial Nephritides,Nephritides, Interstitial,Nephritides, Tubulointerstitial,Tubulointerstitial Nephritides
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000208 Acute Disease Disease having a short and relatively severe course. Acute Diseases,Disease, Acute,Diseases, Acute
D014606 Uveitis, Anterior Inflammation of the anterior uvea comprising the iris, angle structures, and the ciliary body. Manifestations of this disorder include ciliary injection, exudation into the anterior chamber, iris changes, and adhesions between the iris and lens (posterior synechiae). Intraocular pressure may be increased or reduced. Anterior Uveitides,Anterior Uveitis,Uveitides, Anterior

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