Kidney Week

Abstract: SA-PO1153

Chronic Interstitial Nephritis in Agricultural Communities: Two Potential Belgian Cases

Session Information

• CKD: Patient-Oriented Care and Case Reports
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• da Silva Fernandes, Sylvina, Universiteit Antwerpen, Antwerpen, Belgium

Sylvina da Silva Fernandes, MS, MSc

• Simon, Isabelle, Hopital Erasme, Bruxelles, Bruxelles, Belgium

Isabelle Simon, MD

• Wissing, Karl Martin, Universitair Ziekenhuis Brussel, Brussel, Brussel, Belgium

Karl Martin Wissing, MD, MSc, PhD

• Nortier, Joelle L., UVC Brugmann, Brussels, Belgium

Joelle L. Nortier, MD, PhD

• Buhl, Eva Miriam, Universitatsklinikum Aachen Institut fur Pathologie, Aachen, Germany

Eva Miriam Buhl

• Geers, Caroline, Universitair Ziekenhuis Brussel, Brussel, Brussel, Belgium

Caroline Geers, MD

• Nast, Cynthia C., Cedars-Sinai Medical Center, Los Angeles, California, United States

Cynthia C. Nast, MD, FASN

• Boor, Peter, Universitatsklinikum Aachen Institut fur Pathologie, Aachen, Germany

Peter Boor, MD, PhD

• De Broe, Marc E., Universiteit Antwerpen, Antwerpen, Belgium

Marc E. De Broe, MD, PhD

• Vervaet, Benjamin Arthur, Universitatsklinikum Aachen Institut fur Pathologie, Aachen, Germany

Benjamin Arthur Vervaet, PhD

Introduction

Chronic Interstitial Nephritis in Agricultural Communities (CINAC) is a chronic kidney disease of unknown etiology. Currently, CINAC can be diagnosed when patients are active in a farming context, present no or mild hypertension, have no overt proteinuria, and show light microscopic indication of chronic tubulo-interstitial nephritis on biopsy. A histopathological study of our group discovered enlarged (>1,2 µm) dysmorphic lysosomes containing dispersed round aggregates in proximal tubular cells as a prevalent feature of CINAC. Therefore, we hypothesize that verifying this lesion strengthens the CINAC diagnosis when observed in the aforementioned clinico-epidemiological context and helps uncover new cases.

Case Description

In 2023 two Belgian nephrologists independently admitted CKD patients for renal biopsy who fitted the minimal criteria for CINAC (Table). Patient 1, a 50-year-old male, originated from El Salvador where he assisted and worked in pesticide spraying, without protection, from the age of 10 to 32 before moving to Belgium in 2016 with developing CKD. Patient 2, a 71-year-old male, has been a floriculturist for 50 years with often use of pesticides, although with mask protection. Both patients had features of chronic interstitial nephritis in biopsy with a range of healthy and damaged tubuli, some of which showed the abnormal lysosomal lesions. Electron microscopy confirmed the presence of several enlarged, dysmorphic lysosomes containing moderate- to well-defined electron-dense aggregates.

Discussion

We describe two cases of suspected CINAC, that show the presence of abnormal lysosomal lesions, the first cases identified in Belgium. Albeit rare outside of the typical geographic localization, CINAC should be considered in the differential diagnosis of CKD cases of unknown etiology.