A case of furosemide induced acute interstitial nephritis in a patient with nephrotic syndrome

Lee, Seung Hoon; Kang, Eun Hee; Kim, Sang Hyun; Park, Won Do; Lee, Hyun Sun

Abstract

Acute interstitial nephritis may result from a variety of causes and may present a variety of clinical and laboratory findings. If there was or going deterioration of renal function in patients with glomerular disease but without any evidence of other causes for that especially after administration of drug, acute interstitial nephritis should be considered as one possible causes for that Acute interstitial nephritis may be progressing more rapidly than expected but since acute interstitial nephritis is reversible with withdrawal of the drug, its early detection is very important. Acute interstitial nephritis induced by furosemide is rarely reported. But furosemide is a well know drug commonly used in the management of edema due to various causes. Therefore considering furosemide as one possible cause of acute interstitial nephritis is clmicaly important. We experienced a case of acute interstitial nephritis in a 29 year old man with nephrotic syndrome after treatment of furosemide. On admission, physical examination lower extremities revealed severe pitting edema. Serum creatinine level was 1.2 mg/dL. For edema control, we started furosemide therapy. After furosemide therapy, his serum creatinine level was elevated to 3.5mg/dL. He had mild but transient fever. Peripheral eosinophilia, eosinophiluria, skin rash were not observed and threr was no evidence of any infection. Definite diagnoisis was established by renal biopsy and renal biopsy revealed a diffuse interstitial nephritis with dense infiltration by lymphocytes and plasma cells. In addition, moderate tubular atrophy and diffuse interstitial edema was present. The patient recovered promptly after withdrawal of furosemide and with steroid therapy.