Drug-induced acute interstitial nephritis and vasculitis or vasculary rejection in renal allografts

We describe a patient who sought treatment for acute renal allograft dysfun ction 2 weeks after renal transplantation. Renal allograft biopsy (RAB) sho wed intimal arteritis, severe interstitial infiltration with a few eosinoph ils, and severe tubulitis, Pathologic diagnosis was acute rejection (grade 2b- Banff 93); however, another clinical diagnosis, drug-induced acute inte rstitial nephritis (AIN), was not excluded, Before the RAB, his trimethapri m-sulfamethoxazole (TMP-SMZ) treatment was discontinued. Renal function beg an to improve on biopsy day without antirejection therapy, Recovery of rena l function without antirejection treatment and discontinuation of TMP-SMZ s hows that renal pathology might be related to drug-induced dysfunction and drug-induced AIN and vasculitis, After 5 years, the patient and his renal a llograft function are both well. (C) 2001 by the National Kidney Foundation , Inc.