Acute tubulointerstitial nephritis following intravenous immunoglobulin therapy in a male infant with minimal-change nephrotic syndrome

A boy aged 4 years with nephrotic syndrome (NS) was referred to our hospita l because of the third relapse of NS. Hypogammaglobulinemia associated with massive proteinuria was observed at the presentation. Residual urinary tra ct infection required intravenous piperacillin and immunoglobulin therapy ( IVIG). Soon after IVIG, he complained of high fever with chills, bilateral knee joint pain, dry cough and chest discomfort. Although he did not develo p renal insufficiency, a transient increase in the urinary beta(2)-microglo bulin and decrease in the serum complement hemolytic activity were observed . These clinical manifestations spontaneously ceased. A percutaneous renal biopsy for his NS performed 19 days after the episode of allergic rection r evealed tubulointerstitial nephritis (TIN) with marked eosinophil infiltrat es. Glomeruli showed minor glomerular abnormalities. Renal complications as sociated with IVIG treatment have been reported to date, however, acute TIN has rarely been seen. (C) 1999 Tohokru University Medical Press.