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Azithromycin-associated acute interstitial nephritis: clinicopathologic study and comparative review of published reports
Azithromycin-associated acute interstitial nephritis: clinicopathologic study and comparative review of published reports
Juan A. Morales-Ferrer 1 
, Jessica Garduño-López 1 , Nicté Anaya-Benítez 2 , Israel Aguilar-Cozatl 2 , Bernardo De León-Garza 3 , José C. Gasca-Aldama 1
1 Unidad de Cuidados Intensivos, Hospital Juárez de México, Ciudad de México, México; 2 Departamento de Urgencias, Hospital General de Zona No. 20 La Margarita, Instituto Mexicano del Seguro Social, Puebla, Puebla, México; 3 Departamento de Patología, Hospital Regional ISSSTE, Puebla, México
*Correspondence: Juan A. Morales-Ferrer. Email: angelferrer2010@gmail.com
Abstract
Azithromycin-induced acute tubulointerstitial nephritis (ATIN) is a rare cause of acute kidney injury. We report a 19-year-old man who, after exposure to azithromycin, developed rising creatinine, leukocytosis, pyuria, and non-nephrotic proteinuria; obstructive, hemodynamic, infectious, and autoimmune etiologies were excluded. Kidney biopsy showed ATIN with focal tubular injury and a lymphocytic infiltrate. Treatment with corticosteroids was associated with complete recovery of renal function. The drug–event causal relationship was “probable” (Naranjo = 8; ADRs-AKI > 9). This case broadens the clinic-histologic spectrum of macrolide-associated ATIN.
Keywords: Acute tubulointerstitial nephritis. Azithromycin. Drug-induced nephrotoxicity. Renal biopsy. Acute kidney injury.
