Figure 9. Acute allergic interstital nephritis. Acute renal failure necessitating hemodialysis developed following a one week illness characterized by dyspnea, peripheral edema and low-grade fever. Renal ultrasound was essentially normal aside from a large left renal cyst displacing the left kidney anteriorly. A renal scan showed good perfusion with symmetrically reduced function. A diagnosis of acute tubular necrosis (ATN) was made initially based upon renal biopy though no significant antecedent illness was identified. Six weeks later the patient was still dialysis-dependent and the diagnosis was re-evaluated with a gallium scan. Moderate diffuse gallium uptake is seen in both kidneys (arrow on posterior image points to the right kidney, arrow on anterior image points to the left kidney). A repeat biopsy showed typical acute interstitial nephritis with eosinophil infiltration. The patient was treated with prednisone 60 mg daily and within one week his serum creatinine was normal and he was off dialysis. The first renal biopsy was reviewed and in retrospect was felt to show foot process fusion typical of minimal change nephropathy. The combination of minimal change nephropathy and interstitial nephritis has been reported with NSAID's; the patient was on ASA and this is the presumed (but unproven) cause. (Case provided by Dr. W.D. Leslie.)

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