NSAIDs induced Granulomatous Interstitial Nephritis: A Case Report and Literature Review
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Abstract
Acute interstitial nephritis (AIN) affects 15% to 27% of patients with acute kidney injury. Granulomatous interstitial nephritis (GIN) is a type of AIN which has been observed in approximately 0.5–0.9 % of the kidney biopsy specimen. Etiologies of GIN include infection such as tuberculosis, sarcoidosis and medications such as antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), proton pump inhibitor, and uric lowering agents. Removing the cause including treatment of infection and discontinuation of offending drugs is an important part of the management strategy. However, when the recovery of renal function was not satisfactory, moderate to high dose steroid may be helpful in this situation. Here, we reported a 63-year-old man who presented with back pain for four months. He was prescribed two doses of parecoxib injections within a 2-month period. Two months later, his serum creatinine was found to be markedly elevated. Kidney biopsy was performed, and the pathology was consistent with GIN. The diagnosis of NSAIDs induced GIN was entertained. He received high dose oral prednisolone which has resulted in a considerable improvement in kidney function.
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