PMC5735624_01
Renal biopsy demonstrating acute interstitial nephritis (H&E staining): there is edema and an extensive dense interstitial chronic inflammatory infiltrate in the cortex and medulla. (a) In the lower power photomicrograph (left, 100x), the renal cortex shows extensive interstitial chronic inflammation with occasional lymphocytic tubulitis (arrow). In areas of inflammation, there is evidence of acute tubular injury with proximal tubules demonstrating lumenal distension with epithelial flattening. There was no evidence of glomerulitis, vasculitis, or thrombotic microangiopathy. (b) The higher magnification photomicrograph (right, 600x) shows that the interstitial inflammatory cells comprised frequent eosinophils (arrows) as well as lymphocytes and fewer plasma cells.
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The renal biopsy (Figure 1) showed extensive interstitial inflammation with frequent eosinophils and interstitial edema, consistent with drug-induced acute interstitial nephritis (AIN).
Timeline showing the temporal relationship between the start of sunitinib and the rise of creatinine. Note the normal creatinine at baseline and the decrease of creatinine with steroids and hemodialysis.
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Unfortunately, while the patient's renal function somewhat recovered (Figure 2), he succumbed to hospital-acquired pneumonia 2 months after his diagnosis of AIN.