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Masanori Tokumoto, Kyoichi Fukuda, Michiya Shinozaki, Minoru Kashiwagi, Ritsuko Katafuchi, Tetsuhiko Yoshida, Taihei Yanagida, Hidetoshi Kanai, Hideki Hirakata, Kiyoshi Tamaki, Seiya Okuda, Masatoshi Fujishima, Acute interstitial nephritis with immune complex deposition and MHC class II antigen presentation along the tubular basement membrane, Nephrology Dialysis Transplantation, Volume 14, Issue 9, September 1999, Pages 2210–2215, https://doi.org/10.1093/ndt/14.9.2210
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Introduction
Renal tubulointerstitium has been recognized to be a common site of immune-complexes deposition leading to tissue destruction [1–3]. However, cases of interstitial nephritis in which interstitial immune complex deposition play a major role are not commonly reported [4–14]. Most reported cases have been finally diagnosed as either collagen disease or adenovirus-type 11 infection.
Here we present a case of acute interstitial nephritis with tubular immune complex depositions and MHC class II antigen expression defined on the proximal tubular cells.
Case
A 66-year-old Japanese man was admitted to our hospital because of renal functional deterioration on September 19, 1995. He was well until June 1995, when he had had flu-like symptoms with low-grade fever and general malaise. He visited his primary physician in August, and trace proteinuria and increased serum creatinine were noted. Laboratory tests are listed in Table 1. Blood pressure was 144/86 mmHg. He had no skin eruption or peripheral oedema. Urinary sediment was not specific. Mild anaemia (erythrocytes of 419×104/μl and haemoglobin of 12.4 g/dl), and elevated serum total protein, together with a slight decrease in serum albumin was noted. Serum creatinine was 3.6 mg/dl and blood urea nitrogen was 53 mg/dl. Serum chloride was slightly increased (112 mmol/l). The endogenous creatinine clearance was 21.6 ml/min/ 1.73 m2. Serological tests showed hypocomplementaemia (C3 of 24 mg/dl, C4 of 3 mg/dl), a low titre of antinuclear antibody (×40, speckled type), but other autoantibodies such as ds-DNA Ab, SS-A Ab, and SS-B Ab were negative. His serum creatinine rose progressively to 4.7 mg/dl and he was started on corticosteroids (prednisolone 40 mg/day).
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