REGISTRATION
Grand Rounds in Pediatric Nephrology — an ISN-IPNA Sister Centers initiative: A tale of two pathologies: Rapidly progressive glomerulonephritis and Acute tubulointerstitial nephritis
A thirteen-year-old female patient was referred to our facility in Nigeria with nine weeks of reduction in urine output and four weeks of generalized body swelling following abdominal pain. She had anasarca, hypertension, massive nephrotic range proteinuria, haematuria, hypoalbuminaemia, hypercholesterolaemia and progressive renal failure which required haemodialysis. These features suggested nephrotic syndrome manifesting clinically as rapidly progressive glomerulonephritis (RPGN), and prednisolone was initiated. However, on renal biopsy, there was mild interstitial distortion; acute and chronic inflammatory infiltrates, tubular dilatation with necrotic debris, and regeneration of tubules, which suggested tubulointerstitial nephritis (TIN), the immediate cause of which was not identified. A single glomerulus was present and did not show any crescent formation. She eventually succumbed to Escherichia coli septicaemia within twenty-nine weeks of the illness.
This case created a diagnostic dilemma: a patient with dual pathology – RPGN and TIN.
Learning Objectives:
- There are rapid deterioration of renal functions in both diseases, RPGN and tubulointerstitial nephritis (TIN)
- The definitive diagnosis of either of the conditions is based on renal biopsy findings
- Appropriate management of either or dual pathologies of RPGN and TIN will be better understood