Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Aug 13:9:20503121211038470.
doi: 10.1177/20503121211038470. eCollection 2021.

Idiopathic granulomatous interstitial nephritis and isolated renal sarcoidosis: Two diagnoses of exclusion

Ulf Janssen  1 , Shirin Naderi  2 , Kerstin Amann  3
Affiliations
Review

Idiopathic granulomatous interstitial nephritis and isolated renal sarcoidosis: Two diagnoses of exclusion

Ulf Janssen et al. SAGE Open Med. .

Abstract

Granulomatous interstitial nephritis is a rare finding in renal biopsy caused by drugs, infections, and inflammatory or autoimmune diseases. Idiopathic cases account for 18% of granulomatous interstitial nephritis in native kidneys. Sarcoidosis and drugs are the most common causes of granulomatous interstitial nephritis in Western countries, while in India tuberculosis prevails. Few cases of renal sarcoidosis without extrarenal involvement, that is, isolated renal sarcoidosis, have been reported. The diagnostic criteria of isolated renal sarcoidosis remain, however, unclear. Extrarenal sarcoidosis and other etiologies of granulomatous interstitial nephritis, in particular drug-related, have to be excluded. Some of these patients may develop extrarenal manifestations during follow-up. Changes in calcium and vitamin D metabolism are frequently observed in renal sarcoidosis and support its diagnosis. While non-necrotizing granulomas are a feature of sarcoidosis and drug-induced granulomatous interstitial nephritis, they also prevail in tuberculosis-associated granulomatous interstitial nephritis. Granulomatous interstitial nephritis caused by sarcoidosis and drugs usually responds to steroid therapy. A poor response to steroids may indicate an infectious etiology such as tuberculosis and should lead to a review of the initial diagnosis. This article gives an overview of the various etiologies of granulomatous interstitial nephritis, their frequency and histopathological characteristics, as well as potential biomarkers associated with renal sarcoidosis.

Keywords: Granuloma; interstitial nephritis; kidney; sarcoidosis.

PubMed Disclaimer

Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Granulomatous interstitial nephritis with non-necrotizing epithelioid cell granulomas (*), multinucleated giant cells (→), and interstitial inflammatory cell infiltration. PAS stain ×100.
Figure 2.
Figure 2.
Ill-defined epithelioid cell granuloma with central necrosis (*). HE stain ×200.
Figure 3.
Figure 3.
Ill-defined epithelioid cell granuloma with eosinophilic interstitial cell infiltration. HE stain ×200.
See this image and copyright information in PMC

References

    1. Mignon F, Mery JP, Mougenot B, et al.. Granulomatous interstitial nephritis. Adv Nephrol Necker Hosp 1984; 13: 219–245. - PubMed
    1. Viero RM, Cavallo T.Granulomatous interstitial nephritis. Hum Pathol 1995; 26: 1347–1353. - PubMed
    1. Shah S, Carter-Monroe N, Atta MG.Granulomatous interstitial nephritis. Clin Kidney J 2015; 8(5): 516–523. - PMC - PubMed
    1. Joss N, Morris S, Young B, et al.. Granulomatous interstitial nephritis. Clin J Am Soc Nephrol 2007; 2: 222–230. - PubMed
    1. Javaud N, Belenfant X, Stirnemann J, et al.. Renal granulomatoses: a retrospective study of 40 cases and review of the literature. Medicine 2007; 86(3): 170–180. - PubMed

LinkOut - more resources