Letter to the Editor – Brief papers about basic research or clinical experiences
IgA nephropathy associated with acute interstitial nephritis after administering iodinated contrast media
Nefropatía IgA asociada a nefritis intersticial aguda tras administración de contraste yodado
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0 => array:4 [ "autoresLista" => "María Valdenebro, María Marques, Esther Rubio, Edwin Palomino, Estefanya García, Jeanette Fernández, Ana Huerta, Carmen Bellas, José Portolés" "autores" => array:9 [ 0 => array:4 [ "nombre" => "María" "apellidos" => "Valdenebro" "email" => array:1 [ 0 => "mdev183@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "María" "apellidos" => "Marques" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Esther" "apellidos" => "Rubio" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Edwin" "apellidos" => "Palomino" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Estefanya" "apellidos" => "García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "Jeanette" "apellidos" => "Fernández" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 6 => array:3 [ "nombre" => "Ana" "apellidos" => "Huerta" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 7 => array:3 [ "nombre" => "Carmen" "apellidos" => "Bellas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 8 => array:3 [ "nombre" => "José" "apellidos" => "Portolés" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Universitario Puerta de Hierro/REDInREN, ISCiii, Majadahonda, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario Puerta de Hierro/REDInREN, ISCiii, Majadahonda, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nefropatía IgA asociada a nefritis intersticial aguda tras administración de contraste yodado" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 706 "Ancho" => 1808 "Tamanyo" => 198064 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Immunofluorescence in conjugated antibodies showing diffuse granular mesangial uptake for C3 and IgA.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">IgA nephropathy (IgAN) is known to be the most common cause of glomerular disease and the clinical course is variable ranging from microhematuria and isolated proteinuria to acute renal failure (ARF) or rapidly progressive GN. IgAN often presents with ARF due to tubular necrosis (ATN)<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a>; however, biopsy findings of eosinophilia, tubulitis, and interstitial eosinophils, which are typical of acute interstitial nephropathies (AIN), and its association with the use of iodinated (IC) contrast media, are exceptional.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Therefore, we believe that renal biopsies (RB) should be performed in ARF, even when its cause appear to be clear, as with the use of IC. In our case of ARF, the starting point was a case with typical presentation of ATN resulting from IC; yet, the RB showed overlap with a severe form of IgAN and severe tubulointerstitial damage.</p><p id="par0015" class="elsevierStylePara elsevierViewall">A 73-year-old male patient, with a history of high blood pressure, diabetes mellitus (DM), normal renal function (RF), serum creatinine (SC): 1.0<span class="elsevierStyleHsp" style=""></span>mg/dl, and urine without abnormalities.</p><p id="par0020" class="elsevierStylePara elsevierViewall">A month before consultation he had undergone embolization of a giant bi-lobulated aneurysm of the anterior cerebral artery, requiring intravenous IC. Five days later, he developed progressive impairment of RF with SC: 1.6<span class="elsevierStyleHsp" style=""></span>mg/dl, eosinophilia: 7.90<span class="elsevierStyleHsp" style=""></span>cells/mm<span class="elsevierStyleSup">3</span>, and persistent microhematuria. The ultrasound revealed normal kidneys, and autoimmunity tests were negative. RB was not considered because of fever of unknown origin and negative blood and urine cultures. Empirical treatment with steroids 1<span class="elsevierStyleHsp" style=""></span>mg/kg was started, resulting in a rapid decrease of SC levels.</p><p id="par0025" class="elsevierStylePara elsevierViewall">RF was progressively impaired in subsequent controls, resulting in SC: 2.3<span class="elsevierStyleHsp" style=""></span>mg/dl, microhematuria: 50–60 red blood cells/field, proteinuria: 0.8<span class="elsevierStyleHsp" style=""></span>g/24<span class="elsevierStyleHsp" style=""></span>h, without eosinophilia at 15 days; and so readmission for RB was decided.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Renal biopsy showed glomeruli with an increased mesangial matrix and cell proliferation. Tubules had severe tubulitis, signs of ATN with epithelial flattening and loss of brush border, and extensive interstitial inflammatory infiltration with the presence of eosinophils (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Immunofluorescence revealed granular deposits of IgA and C3 within the mesangium (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The patient was diagnosed of IgAN with severe acute tubulointerstitial involvement suggestive of AIN. Treatment with prednisone 1<span class="elsevierStyleHsp" style=""></span>mg/kg/day was initiated, and renal function stabilized although SC levels did not return to baseline after 2 months of follow-up (SC: 2.2<span class="elsevierStyleHsp" style=""></span>mg/dl).</p><p id="par0040" class="elsevierStylePara elsevierViewall">From nephrologist's perspective, RB is an essential procedure with well-established indications for the study of variety of renal diseases. It confirm the diagnoses, determine prognosis, and helps to stabilize the right treatment. It is most commonly used in cases of nephrotic syndrome, abnormal urine tests, and unclear ARF. Our patient is a real example of the importance of confirming clinical suspicions with histological findings of RB. IgAN is the most common primary renal disease, but it can also progress to some form of “superimposed” glomerulonephritis (GM) in patients with diabetic nephropathy who develop ARF of any cause. In the series of Castellano et al., IgAN, together with membranous GM and vasculitis, were the most common non-diabetic conditions found in RBs among these patients.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> This has led to a discussion over the role of abnormal synthesis and the degradation of glomerular basement membrane and mesangial matrix which is characteristic of these cases, with haemodynamic factors and nonenzymatic glycosylation being typical of DM.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The association of IgAN with ARF and IC media is also common since hypersensitivity reactions result in changes in T cell receptors and cytokine release, thereby activating cell and humoral immunity. These findings would account for the link between AIN and the use of IC. Nonetheless, their actual prevalence is underestimated by their confirmatory diagnosis, because of the bias against performance of RBs in most patients with ARF.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> AIN is well-known to benefit from early treatment with steroids. González et al. studied the outcome of 61 patients diagnosed with drug-induced AIN by RB<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a>: 85% received steroids and achieved final improvement of RF and decreased need of dialysis.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Presentation and outcome in this patient with AIN and IgAN illustrates the importance of RB among patients with ARF of uncertain etiology. This leads to early initiation of the appropriate treatment to improve prognosis for our patients and it also provides important clinical information in patients with poor outcomes (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>).</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Valdenebro M, Marques M, Rubio E, Palomino E, García E, Fernández J, et al. Nefropatía IgA asociada a nefritis intersticial aguda tras administración de contraste yodado. Nefrologia. 2015;35:582–584.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 771 "Ancho" => 1958 "Tamanyo" => 350915 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Glomeruli with mesangial hypercellularity and interstitial expansion by inflammatory cells and eosinophils. Severe tubulointerstitial inflammation and tubulitis.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 706 "Ancho" => 1808 "Tamanyo" => 198064 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Immunofluorescence in conjugated antibodies showing diffuse granular mesangial uptake for C3 and IgA.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The spectrum of acute renal failure in IgA nephropathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Y.K. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 17 | 13 | 30 |
| 2024 October | 90 | 58 | 148 |
| 2024 September | 110 | 31 | 141 |
| 2024 August | 105 | 73 | 178 |
| 2024 July | 88 | 42 | 130 |
| 2024 June | 120 | 55 | 175 |
| 2024 May | 105 | 39 | 144 |
| 2024 April | 93 | 26 | 119 |
| 2024 March | 99 | 32 | 131 |
| 2024 February | 78 | 44 | 122 |
| 2024 January | 66 | 24 | 90 |
| 2023 December | 68 | 16 | 84 |
| 2023 November | 89 | 25 | 114 |
| 2023 October | 74 | 23 | 97 |
| 2023 September | 72 | 21 | 93 |
| 2023 August | 58 | 26 | 84 |
| 2023 July | 79 | 28 | 107 |
| 2023 June | 116 | 20 | 136 |
| 2023 May | 108 | 28 | 136 |
| 2023 April | 69 | 24 | 93 |
| 2023 March | 122 | 18 | 140 |
| 2023 February | 166 | 17 | 183 |
| 2023 January | 68 | 20 | 88 |
| 2022 December | 78 | 27 | 105 |
| 2022 November | 74 | 20 | 94 |
| 2022 October | 95 | 41 | 136 |
| 2022 September | 69 | 23 | 92 |
| 2022 August | 90 | 44 | 134 |
| 2022 July | 67 | 37 | 104 |
| 2022 June | 94 | 25 | 119 |
| 2022 May | 106 | 24 | 130 |
| 2022 April | 117 | 46 | 163 |
| 2022 March | 83 | 41 | 124 |
| 2022 February | 90 | 41 | 131 |
| 2022 January | 83 | 35 | 118 |
| 2021 December | 83 | 45 | 128 |
| 2021 November | 82 | 35 | 117 |
| 2021 October | 127 | 46 | 173 |
| 2021 September | 85 | 31 | 116 |
| 2021 August | 84 | 42 | 126 |
| 2021 July | 73 | 35 | 108 |
| 2021 June | 79 | 35 | 114 |
| 2021 May | 99 | 31 | 130 |
| 2021 April | 214 | 54 | 268 |
| 2021 March | 124 | 30 | 154 |
| 2021 February | 84 | 36 | 120 |
| 2021 January | 69 | 18 | 87 |
| 2020 December | 71 | 26 | 97 |
| 2020 November | 64 | 25 | 89 |
| 2020 October | 43 | 30 | 73 |
| 2020 September | 89 | 15 | 104 |
| 2020 August | 66 | 25 | 91 |
| 2020 July | 78 | 15 | 93 |
| 2020 June | 62 | 15 | 77 |
| 2020 May | 76 | 10 | 86 |
| 2020 April | 67 | 21 | 88 |
| 2020 March | 60 | 8 | 68 |
| 2020 February | 73 | 14 | 87 |
| 2020 January | 71 | 20 | 91 |
| 2019 December | 97 | 21 | 118 |
| 2019 November | 55 | 19 | 74 |
| 2019 October | 54 | 19 | 73 |
| 2019 September | 65 | 13 | 78 |
| 2019 August | 62 | 20 | 82 |
| 2019 July | 78 | 17 | 95 |
| 2019 June | 47 | 29 | 76 |
| 2019 May | 55 | 22 | 77 |
| 2019 April | 105 | 39 | 144 |
| 2019 March | 68 | 30 | 98 |
| 2019 February | 43 | 14 | 57 |
| 2019 January | 75 | 30 | 105 |
| 2018 December | 176 | 37 | 213 |
| 2018 November | 287 | 22 | 309 |
| 2018 October | 236 | 22 | 258 |
| 2018 September | 129 | 25 | 154 |
| 2018 August | 83 | 12 | 95 |
| 2018 July | 75 | 16 | 91 |
| 2018 June | 84 | 14 | 98 |
| 2018 May | 109 | 9 | 118 |
| 2018 April | 128 | 15 | 143 |
| 2018 March | 131 | 14 | 145 |
| 2018 February | 110 | 8 | 118 |
| 2018 January | 89 | 9 | 98 |
| 2017 December | 94 | 4 | 98 |
| 2017 November | 68 | 10 | 78 |
| 2017 October | 64 | 7 | 71 |
| 2017 September | 45 | 5 | 50 |
| 2017 August | 67 | 16 | 83 |
| 2017 July | 47 | 7 | 54 |
| 2017 June | 64 | 14 | 78 |
| 2017 May | 80 | 14 | 94 |
| 2017 April | 38 | 11 | 49 |
| 2017 March | 43 | 7 | 50 |
| 2017 February | 117 | 32 | 149 |
| 2017 January | 51 | 10 | 61 |
| 2016 December | 35 | 6 | 41 |
| 2016 November | 83 | 17 | 100 |
| 2016 October | 127 | 10 | 137 |
| 2016 September | 144 | 3 | 147 |
| 2016 August | 158 | 8 | 166 |
| 2016 July | 110 | 10 | 120 |
| 2016 June | 78 | 0 | 78 |
| 2016 May | 123 | 0 | 123 |
| 2016 April | 104 | 0 | 104 |
| 2016 March | 77 | 0 | 77 |
| 2016 February | 91 | 0 | 91 |
| 2016 January | 66 | 0 | 66 |
| 2015 December | 48 | 0 | 48 |
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