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2015 ; 2015
(ä): 250530
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Allergic Interstitial Nephritis Manifesting as a Striated Nephrogram
#MMPMID26664405
Moinuddin I
; Bracamonte E
; Thajudeen B
; Sussman A
; Madhrira M
; Costello J
Case Rep Med
2015[]; 2015
(ä): 250530
PMID26664405
show ga
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.