Acute Tubulointerstitial Nephritis in Clinical Oncology: A Comprehensive Review

Abstract

Acute kidney injury in patients who suffer a malignancy is a common complication. Due to its high prevalence and effective treatment, one of the most frequent causes that both oncologists and nephrologists must be aware of is acute tubulointerstitial nephritis (ATIN). ATIN is an immunomediated condition and the hallmark of the disease, with the presence of a tubulointerstitial inflammatory infiltrate in the renal parenchyma. This infiltrate is composed mainly of T lymphocytes that can be accompanied by macrophages, neutrophils, or eosinophils among other cells. One of the major causes is drug-related ATIN, and some antineoplastic treatments have been related to this condition. Worthy of note are the novel immunotherapy treatments aimed at enhancing natural immunity in order to defeat cancer cells. In the context of the immunosuppression status affecting ATIN patients, some pathogen antigens can trigger the development of the disease. Finally, hematological malignancies can also manifest in the kidney leading to ATIN, even at the debut of the disease. In this review, we aim to comprehensively examine differential diagnosis of ATIN in the setting of a neoplastic patient.

Keywords: acute kidney injury; acute tubulointerstitial nephritis; onconephrology.

Figure 1

Light microscopy images illustrating acute interstitial nephritis cases with characteristic features. Panel (A). Extensive interstitial inflammatory infiltrates in a case of drug-induced acute tubulointerstitial nephritis. Eosinophils associated with peritubular infiltrates (*) (hematoxylin and eosin, 200×). Panel (B). Acute tubulointerstitial nephritis associated with Bacillus Calmette–Guerin treatment. Interstitial necrotizing granuloma (hematoxylin and eosin, 100x). Panel (C). Acute tubulointerstitial nephritis associated with BK virus infection. Intranuclear inclusions (*) and vacuolated cytoplasm (hematoxylin and eosin, 400×). Panel (D,E). Lymphocytic infiltration of the kidney in a patient diagnosed with marginal zone lymphoma. Infiltrating cells are CD20 positive (hematoxylin and eosin, 10×).