Granulomatous tubulointerstitial nephritis in the renal allograft

Granulomatous tubulointerstitial nephritis has rarely been described in ren al allografts. Of 1,574 renal allograft tissue specimens obtained from 514 patients in the period 1993 to 1998, we report three cases (0.6%) with inte rstitial nephritis containing multiple noncaseating granulomas. Biopsy spec imen 1 was obtained from a 44-year-old woman with a 6-day history of system ic Candida albicans infection and showed multiple granulomas containing bud ding yeasts. Biopsy specimen 2 was from a 33-year-old man who presented wit h miliary spread of Mycobacterium tuberculosis 12 days before the allograft biopsy. Biopsy specimen 3 was from a 23-year-old woman who presented with Escherichia coli urinary infection and bacteremia that was treated with ant ibiotics for 10 days before the biopsy. Granulomatous inflammation in respo nse to infectious agents or drugs in immunosuppressed kidney transplant rec ipients can rarely give rise to allograft interstitial nephritis that is di stinct from acute rejection. To our knowledge, there are no prior reports o f granulomatous tubulointerstitial nephritis associated with C albicans end E coil infection or antibiotic therapy in human renal allografts. (C) 2000 by the National Kidney Foundation, Inc.