Abstract

Background: Acute granulomatous interstitial nephritis (AGIN) in native kidneys is most commonly linked to drugs. In allografts, it is a rare complication, and it occurs mostly with infections. Case presentation: Our case report presents AGIN with simultaneous acute cellular rejections and acute tubular necrosis in a kidney transplant patient 2 weeks after intravenous application of zoledronic acid. A kidney biopsy showed signs of destructive AGIN with acute cellular rejection. After treatment with methylprednisolone pulses and immunosuppressive therapy modification, rebiopsy confirmed complete regression of AGIN with less intense persistent acute cellular rejection and acute tubular necrosis. Kidney function improved after glucocorticoid and intravenous immunoglobulin G therapy. Conclusion: To our knowledge, this is the first case of AGIN related to bisphosphonate zoledronate in a kidney transplant patient with consequent acute cellular rejection. In using intravenous zoledronate infusion in a kidney transplant recipient, we should be aware that it could potentially induce acute granulomatous tubulointerstitial nephritis and acute rejection.


Author Details

Authors

• Nuša Avguštin¹
• Damjan Kovač¹
• Nika Kojc²
• Gregor Mlinšek²
• Jelka Lindič¹

Departments

• ¹ Department of Nephrology, University Medical Center Ljubljana, and
• ² Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia

Address

Jelka Lindič, MD, PhD
Department of Nephrology
University Medical Center Ljubljana
Zaloška cesta 7, 1000 Ljubljana, Slovenia
Email: [email protected]

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