Drug-Induced Sarcoid-Like Granulomatous Interstitial Nephritis in a Patient with JIA

Received: Oct 02, 2012 Accepted: Nov 04, 2012 Ann Paediatr Rheum 2012; 1:231-236 DOI: 10.5455/apr.110420121342 Introduction Juvenile idiopathic arthritis ( JIA), consisting of heterogeneous clinical features, is the most common rheumatologic disease in children [1]. Onset of the disease is observed before the age of 16. 10% of patients suffer chronic anterior uveitis which is a major cause of visual loss [2-5]. Systemic onset juvenile idiopathic arthritis (SoJIA) is a subset of JIA, which is manifested by intermittent fever, rash, and arthritis. SoJIA may begin as early as the first or second year of life. Nonsteroidal antiinflammatory drugs (NSAIDs) alone are effective for most children with systemic onset juvenile idiopathic arthritis ( JIA) [6]. Second line agents, such as glucocorticoids or methotrexate are used, if NSAIDs are ineffective. TNFa inhibitor therapy was recommended for patients who had received 3 months of methotrexate but still had moderate or high disease activity [7]. Granulomatous interstitial nephritis (GIN) has been shown to be related with administration of antibiotics, analgesics and diuretics, in patients with sarcoidosis, tuberculosis, or Wegener’s granulomatosis [8]. It is unclear whether the presence of granulomas in interstitial nephritis affects the prognosis of renal failure [9]. We report a case of interstitial granulomatous nephritis presenting with acute renal failure in an on treatment JRA patient. Abstract