4 research outputs found

    A renal biopsy-based clinicopathological study of primary tubulointerstitial nephritis in children

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    Background: Inflammation of the tubular and interstitial compartment without involving the glomeruli and vessels is called as primary tubulointerstitial nephritis (TIN), which may be due to varied etiologies. This is relatively uncommon in children as compared to primary glomerular disorders. Infections and drugs are the most common causes of primary TIN worldwide. Objectives: The objectives of the study were to assess primary TIN in pediatric patients using findings from renal biopsies at a tertiary care center of Western India. Materials and Methods: All biopsy-proven cases of primary TIN in pediatric patients over a period of 10 years were included in the study. All cases with glomerular or vascular diseases, or where data were inadequate were excluded from the study. The cases were reviewed in detail for epidemiological data, clinical presentation, etiology, and histomorphological features. Depending on their clinical and morphological features, the cases were categorized into acute, chronic, and granulomatous TIN. Results: A total of 30 cases of primary TIN were assessed with a mean age of 12.4 years and range of 6–18 years. Pedal edema and facial puffiness were the most common symptoms followed by oliguria. The common causes of TIN were drugs, namely antibiotics and non-steroidal anti-inflammatory drugs and infections. Acute TIN was more common than chronic TIN. Conclusion: Primary TIN is an uncommon renal disease in pediatric patients with varied presentations and etiologies. However, early diagnosis by renal biopsy, detailed history, and withdrawal of the offending agent along with prompt treatment helps in recovery and avoids chronic renal damage

    Mercury-associated neural epidermal growth factor-like 1 protein (NELL-1) positive membranous nephropathy after use of skin lightening creams

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    Membranous nephropathy, one of the common causes of glomerulonephritis worldwide, is reported in association with mercury exposure. Neural epidermal growth factor-like 1 protein is a recently described target antigen in membranous nephropathy. Three woman (ages 17, 39, and 19 years old) presented sequentially for our evaluation with complaints consistent with nephrotic syndrome. All three had nephrotic range proteinuria, hypoalbuminemia, hypercholesterolemia, hypothyroidism, and inactive urinary sediments. Kidney biopsies were performed in the first two patients, which demonstrated findings consistent with membranous nephropathy and positive staining for neural epidermal growth factor-like 1 protein. On discovery that they were all using the same skin-lightening cream, samples of the cream were tested and found to contain between 2,180 parts per million and 7,698 parts per million of mercury. Elevated urine and blood mercury concentrations were also found in the first two patients. All three patients improved following cessation of use and treatment with levothyroxine (all three patients) and corticosteroids and cyclophosphamide in patients one and two. We hypothesize the role of autoimmunity triggered by mercury exposure in the pathogenesis of neural epidermal growth factor-like 1 protein membranous nephropathy. Mercury exposure should be carefully assessed as a part of the evaluation of patients with neural epidermal growth factor-like 1 protein positive membranous nephropathy.</p