Glucocorticoid therapy for acute interstitial nephritis in a patient with diabetic nephropathy: A case report.
Yaguang Xu, Tianshu Wang, Hongjiao Zhang et al.
✦ AI-curated · Sources linked
Case in brief
A 41-year-old man with diabetes and hypertension developed acute kidney dysfunction after previously normal renal function; he had used an unidentified herbal decoction during the preceding month. Biopsy showed acute tubular injury, mild tubulitis and interstitial inflammation consistent with acute interstitial nephritis (AIN), alongside class IIa diabetic nephropathy. Infection and systemic autoimmune disease were not identified. After the decoction had been discontinued, prednisone was started, with tapering and discontinuation. Kidney function improved, as did other reported renal and metabolic measures. Steroid-associated hyperglycemia was managed with insulin, and insomnia improved during tapering.
What made this case unusual
Biopsy demonstrated AIN and diabetic nephropathy together, complicating attribution of acute kidney dysfunction in a patient with diabetes. The herbal decoction was considered a possible AIN trigger, not a confirmed cause.
Diagnostic / clinical pearl
Consider kidney biopsy when a patient with diabetes develops acute kidney dysfunction: AIN may coexist with diabetic nephropathy, and biopsy can identify both processes.