Ewha Med J.  2015 Mar;38(1):36-41. 10.12771/emj.2015.38.1.36.

Renal Parenchymal Malakoplakia with Acute Interstitial Nephritis Presented with Acute Kidney Injury

• Han IM
• Kee YK
• Lee E
• Lee CK
• Han SG
• Heo SJ
• Yoo TH

• KMID: 2171327
• DOI: http://doi.org/10.12771/emj.2015.38.1.36

Abstract

Malakoplakia is an uncommon chronic granulomatous inflammatory disease which is associated with immunocompromised conditions such as malignancy, autoimmune disease, chronic alcohol intake, poorly controlled diabetes and long-term steroid use. Malakoplakia can occur at various sites, most commonly in the genitourinary tract including urinary bladder and the ureter. Renal parenchymal involvement is relatively uncommon, accounting for 15% of all malakoplakia. A few cases of renal malakoplakia have been reported in Korea, and only one case was accompanied by acute kidney injury. Here we report an 80-year-old female patient with renal parenchymal malakoplakia and acute interstitial nephritis presented as acute kidney injury with literature review.

Keyword

Interstitial nephritis; Acute kidney injury

MeSH Terms

Acute Kidney Injury*
Aged, 80 and over
Autoimmune Diseases
Female
Humans
Korea
Malacoplakia*
Nephritis, Interstitial*
Ureter
Urinary Bladder

Figure

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  Fig. 1 Abdomino-pelvic CT on admission. It demonstrates multifocal attenuation differences at both kidneys (A) and normal-sized kidneys without hydronephrosis (B).

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  Fig. 2 Renal biopsy specimen they show (A) localized moderate fibrosis with dense histiocytic infiltrates, (B) mild lymphoplasma cell and eosinophilic infiltrates, (C) foam cells surrounding the interstitium and tubules (H&E, ×200), and (D) histiocytes with round concentric layered intracytoplasmic Michaelis-Gutmann bodies (Periodic acid-Schiff, ×200).

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  Fig. 3 Immunohistochemical stain. It demonstrates strong reactivity for CD68 (A, ×40; B, ×200).

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  Fig. 4 Trends in serum creatinine and Creactive protein during follow-up period.

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