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Acute Pyelonephritis I: Introduction01:27

Acute Pyelonephritis I: Introduction

Pyelonephritis is a bacterial infection that primarily affects the renal parenchyma and collecting system, including the renal pelvis, tubules, and interstitial tissue of one or both kidneys. It can be classified as either acute—a sudden, severe infection—or chronic, which refers to long-term or recurrent kidney infections.The primary cause of acute pyelonephritis (APN) is bacterial infection, with Escherichia coli accounting for approximately 70-80% of cases. Other bacteria, such as Proteus,...
Acute Pyelonephritis II: Diagnostic Studies and Management01:28

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Introduction:For diagnosing acute pyelonephritis, a comprehensive patient history is collected to identify symptoms such as dysuria, frequent or urgent urination, flank pain, or costovertebral angle (CVA) tenderness that may suggest a kidney infection.Physical ExaminationDuring the physical examination, CVA tenderness is assessed. This involves gentle percussion over the costovertebral angle, where tenderness often indicates a kidney infection.Diagnostic TestsUrinalysis: Used to identify white...
Acute Kidney Injury I: Introduction01:22

Acute Kidney Injury I: Introduction

Introduction:Acute Kidney Injury (AKI) describes a swift decrease in kidney function occurring over hours to days, characterized by the kidneys' failure to remove waste products from the bloodstream. This leads to dangerous complications like metabolic acidosis, fluid overload, and electrolyte imbalances, such as hyperkalemia, which can cause life-threatening arrhythmias. AKI is common in both hospital and outpatient settings, often triggered by dehydration, sepsis, or exposure to nephrotoxic...
Acute Kidney Injury II: Pathophysiology01:29

Acute Kidney Injury II: Pathophysiology

Acute kidney injury (AKI) causes are categorized into three primary categories based on the location of the injury: prerenal, intrarenal (or intrinsic), and postrenal causes. This classification guides clinical management and illustrates how different pathways can impair kidney function.Etiology and Pathophysiology of Acute Kidney Injury1. Prerenal causesEtiology: Prerenal Acute Kidney Injury, the most common type, occurs when reduced blood flow to the kidneys decreases filtration capacity...
Acute Kidney Injury III: Clinical Manifestations01:29

Acute Kidney Injury III: Clinical Manifestations

Acute Kidney Injury (AKI) progresses through distinct clinical phases: the oliguric, diuretic, and recovery phases, each marked by unique manifestations and challenges.Oliguric Phase:The oliguric phase is the initial stage of AKI, typically lasting 10 to 14 days. This phase is marked by a significant reduction in urine output, usually less than 400 mL per day, indicating decreased kidney function. Fluid retention is a prominent feature, leading to symptoms such as edema, hypertension, and...
Acute Kidney Injury IV: Diagnostic Studies and Prevention01:30

Acute Kidney Injury IV: Diagnostic Studies and Prevention

Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...

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Brentuximab-Induced Acute Interstitial Nephritis: A Case Report.

Matthew Patterson1, Pouneh Dokouhaki2, Chance S Dumaine1

  • 1Division of Nephrology, Department of Medicine, University of Saskatchewan, Saskatoon, Canada.

Canadian Journal of Kidney Health and Disease
|November 26, 2024
PubMed
Summary

Brentuximab vedotin, used for certain lymphomas, can rarely cause acute interstitial nephritis (AIN), a kidney injury. This case highlights a novel histopathologic finding of AIN in a patient treated with brentuximab.

Keywords:
AKI (acute kidney injury)brentuximabinterstitial nephritis

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Area of Science:

  • Nephrology
  • Oncology
  • Pathology

Background:

  • Brentuximab vedotin is an anti-CD30 antibody-drug conjugate approved for treating mycosis fungoides, Hodgkin's lymphoma, and anaplastic large cell lymphoma.
  • While generally well-tolerated, renal complications are infrequently reported.
  • Acute kidney injury (AKI) is a rare but serious potential adverse reaction.

Purpose of the Study:

  • To report a rare case of acute interstitial nephritis (AIN) secondary to brentuximab vedotin treatment.
  • To describe the clinical presentation, diagnostic findings, and treatment outcome.
  • To highlight a novel histopathologic finding in drug-induced AIN.

Main Methods:

  • Case report of a 73-year-old male with mycosis fungoides.
  • Monitoring of serum creatinine and estimated glomerular filtration rate (eGFR) before and after brentuximab vedotin cycles.
  • Diagnosis of AKI, exclusion of other causes, and confirmation of AIN via kidney biopsy.
  • Treatment with oral prednisone and subsequent taper.

Main Results:

  • The patient developed severe AKI (SCr peak 1073 µmol/L) after his third brentuximab vedotin cycle.
  • Kidney biopsy confirmed acute interstitial nephritis (AIN) with a tubulointerstitial inflammatory infiltrate.
  • Treatment with prednisone led to partial recovery of renal function (SCr 156 µmol/L).
  • The histopathology was consistent with AIN, a pattern typically seen with immune checkpoint inhibitors (ICIs), though brentuximab is not an ICI.

Conclusions:

  • This case represents a rare renal complication of brentuximab vedotin, specifically acute interstitial nephritis.
  • The histopathologic findings of AIN in this case are novel for a non-ICI medication.
  • Physicians should be vigilant for renal adverse events in patients treated with brentuximab vedotin, even if rare.