Abstract: SA-PO076
AKI due to Acute Tubulo-Interstitial Nephritis and Diabetic Nephropathy in a Patient with Pulmonary Aspergillosis
Session Information
- AKI: Epidemiology, Risk Factors, Prevention - II
November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 101 AKI: Epidemiology, Risk Factors, and Prevention
Authors
- Calderon Garcia, Clementina Elizabeth, Hospital Civil de Guadalajara Unidad Hospitalaria Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
- Navarro Blackaller, Guillermo, Hospital Civil de Guadalajara Unidad Hospitalaria Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
- Zavala López, Eric Javier, Hospital Civil de Guadalajara Unidad Hospitalaria Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
- Chavez, Jonathan, Hospital Civil de Guadalajara Unidad Hospitalaria Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
Introduction
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Case Description
A 45-year-old woman with diabetes mellitus, 8 years of evolution in poor control, asthma, and chronic smoking.
Admited with hyperglycemic crisis due to pneumonia: procalcitonin 0.3, Hb 16g/dl, WBC 16, albumin 3.74g/dl, SCr 0.79mg/dl, urea 25mg/dl, glucose 933mg/dl, HbA1c 14%.
Patient presents cough, fever, hemoptysis, a chest tomography with pulmonary infiltrates and cavitated nodules. Bronchoscopy reported Aspergillus. Management with liposomal amphotericin, presented acute kidney injury, SCr 4 mg/dl, proteinuria 1g/24hrs, urinary sediment: leukocytosis, erythrocytes without acanthocytes. Renal biopsy reports: Acute tubulointerstitial nephritis (aTIN), presence of a mixed lymphoplasmacytic infiltrate of lymphocytes and eosinophils suggestive of aTIN due to drugs and a concomitant diabetic nephropathy (Thickening of glomerular capillaries, diffuse glomerulosclerosis, with mesangial expansion and Kimmelstiel-Wilson nodules).
Management with pulsed methylprednisolone 250mg and prednisone 0.5mg/kg per day for 6 weeks.
Discussion
aTIN is a form of glomerular-sparing non-oliguric renal disease that results from an allergic or immunologic reaction to intrarenal antigens and leads to tubular damage. The drugs normally associated are NSAIDs, antibiotics, and proton pump. Our patient was exposed to liposomal amphotericin. In the case series of renal biopsies in patients with DM2 (4876 patients), the prevalence of glomerulopathy not associated with DN was up to 35% and mixed forms 45%.
Conclusion
In the case that we present a patient living with chronic and poorly controlled diabetes who presented AKI, DN, the AKI approach must be considered regardless of comorbidities where the use of drugs is not innocuous.