Allergic Interstitial Nephritis Manifesting as a Striated Nephrogram

• Published in: Case Reports in Medicine Vol. 2015; no. 2015; pp. 103 - 106-026
• Main Authors: Madhrira, Machaiah, Sussman, Amy N., Thajudeen, Bijin, Bracamonte, Erika, Moinuddin, Irfan, Costello, James
• Format: Journal Article
• Language: English
• Published: Cairo, Egypt Hindawi Limiteds 01-01-2015; Hindawi Publishing Corporation; John Wiley & Sons, Inc; Hindawi Limited
• Subjects: Biopsy; Care and treatment; Case Report; Case studies; Diagnosis; Edema; Family medical history; Gangrene; Immunoglobulins; Inflammation; Kidney diseases; Medical imaging; Nephritis; Neutrophils; NMR; Nuclear magnetic resonance; Thrombosis; Urine; United States
• ISSN: 1687-9627; 1687-9635
• DOI: 10.1155/2015/250530

Allergic interstitial nephritis (AIN) is an underdiagnosed cause of acute kidney injury (AKI). Guidelines suggest that AIN should be suspected in a patient who presents with an elevated serum creatinine and a urinalysis that shows white cells, white cell casts, or eosinophiluria. Drug-induced AIN is suspected if AKI is temporally related to the initiation of a new drug. However, patients with bland sediment and normal urinalysis can also have AIN. Currently, a definitive diagnosis of AIN is made by renal biopsy which is invasive and fraught with risks such as bleeding, infection, and hematoma. Additionally, it is frequently unclear when a kidney biopsy should be undertaken. We describe a biopsy proven case of allergic interstitial nephritis which manifested on contrast enhanced Magnetic Resonance Imaging (MRI) as a striated nephrogram. Newer and more stable macrocyclic gadolinium contrast agents have a well-demonstrated safety profile. Additionally, in the presentation of AKI, gadolinium contrast agents are safe to administer in patients who demonstrate good urine output and a downtrending creatinine. We propose that the differential for a striated nephrogram may include AIN. In cases in which the suspicion for AIN is high, this diagnostic consideration may be further characterized by contrast enhanced MRI.