PEDIATRICS Vol. 43 No. 4 April 1969, pp. 533-539
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RECOVERY FROM RENAL FAILURE DUE TO ACUTE DIFFUSE INTERSTITIAL NEPHRITIS

James H. Knepshield 1, Per Henrik Becher Carstens M.D.1, and Dominick E. Gentile M.D.1

1 Departments of Pediatrics, Medicine (Section on Renal Disease), and Pathology University of Louisville School of Medicine, Louisville, Kentucky

A 3-year-old girl developed acute oliguric renal failure and Coombs' positive hemolytic anemia during the course of a Group A, beta-hemolytic streptococcal infection. Renal biopsy established the diagnosis of acute diffuse interstitial nephritis (ADIN) in combination with tubular necrosis. Electron microscopy of the biopsy specimen confirmed the finding of tubular necrosis and revealed focal areas of dilatation of the basal infoldings from the plasma membrane. The tubular basement membrane was fragmented. Peritoneal dialysis and other supportive measures sustained the patient until adequate renal function returned. To our knowledge, this patient represents the first reported case of recovery from ADIN associated with a streptococcal infection. The latent period between the onset of the infection and the renal manifestations, and the nature of the cellular response seen in the renal biopsy suggest an antigen-antibody reaction as the cause of the renal injury. The cause of oliguria in ADIN remains obscure. However, tubular necrosis is a well-known cause of acute oliguric renal failure and this lesion probably plays a role in the functional impairment of ADIN.

Accepted on November 19, 1968