Varadharajan Jayaprakash
1* 
, Muthukaruppaiah Suganya
1 , Dhanasekaran Karthick
1 , Anila Abraham Kurien
2 , Raghavan Padmanabhan
11 Department of Nephrology, SRM Medical College and Research Centre, SRM Institute of Science and Technology (SRM IST), Kattankulathur, Tamilnadu, India
2 Renopath, Centre for Renal and Urological Pathology, Chennai, India
Abstract
Severe rhabdomyolysis could lead to myoglobinuria and acute kidney injury (AKI). Acute interstitial nephritis (AIN) is commonly caused by drugs. AIN per se can cause ‘severe’ AKI. Renal recovery is delayed when several factors are involved in the pathogenesis of AKI. Survivors of AKI require long-term follow-up. Here, we report a case where both severe rhabdomyolysis and drug-induced AIN contributed to ‘severe’ dialysis-requiring AKI. Renal biopsy was diagnostic and showed characteristic features. Steroid therapy for AIN resulted in partial recovery.
Implication for health policy/practice/research/medical education:
AKI is severe when two or more etiologies are implicated. Renal biopsy should be done when AKI does not recover in two weeks or earlier if AIN is suspected. Immunohistochemistry for myoglobin should be conducted in renal biopsy specimen if rhabdomyolysis is suspected. Survivors of dialysis-requiring ‘severe’ AKI require long-term follow up.
Please cite this paper as: Jayaprakash V, Suganya M, Karthick D, Abraham Kurien A, Padmanabhan R. “Double whammy” to the kidneys: an unusual etiology of acute kidney disease. J Nephropathol. 2023;12(3):e17252. DOI: 10.34172/jnp.2022.17252.