A Case Report Of Acute Tubulo-Interstitial Nephritis (ATIN): Offending Agent C-ANCA

Acute Tubulo-Interstitial Nephritis (ATIN): Offending Agent C-ANCA

Abstract

Background: Antineutrophil cytoplasmic antibody (ANCA) has been reported to be associated with systemic vasculitis. However, there are few reports regarding ATIN and ANCA without drug involvement. In this article, we present a case of ATIN with a high titer of ANCA, without systemic disease or any responsible drug. Here we present a case of A 41 year female, p/w breathlessness at rest, decreased urine output, fever and anorexia for 10 days. She had no other significant medical illness. Laboratory investigations were done where creatinine, urea, potassium levels and ESR were significantly raised and urine analysis showed proteinuria. RA Factor, ANA titre and C- ANCA were positive. Kidneys on USG s/o B/L increase in echogenicity with normal size and preserved CMD. Percutaneous Renal biopsy performed showed tubular atrophy with few foci of lymphocytic tubulitis and focal inratubular neutrophilic casts. Interstitium shows patchy moderate mixed inflammatory infiltrates. Emergency HD was done on admission followed by pulse therapy of Methylprednisone after which her renal function improved and patient got better and was subsequently discharged on oral prednisone. ATIN is a relatively rare pathologic finding among ANCA-related renal injury. ATIN can be associated with positive ANCA without features of renal limited vasculitis or systemic vasculitis and can also occur in absence of drug exposure. [Jalawala N Natl J Integr Res Med, 2023; 14(2): 40-42, Published on Dated: 15/03/2023]