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Case Reports in Medicine
Volume 2015, Article ID 250530, 4 pages
http://dx.doi.org/10.1155/2015/250530
Case Report

Allergic Interstitial Nephritis Manifesting as a Striated Nephrogram

1Division of Nephrology, University of Arizona Medical Center, Tucson, AZ 85724, USA
2Department of Pathology, University of Arizona Medical Center, Tucson, AZ 85724, USA
3Department of Medical Imaging, University of Arizona Medical Center, Tucson, AZ 85724, USA

Received 6 August 2015; Accepted 10 November 2015

Academic Editor: Masahiro Kohzuki

Copyright © 2015 Irfan Moinuddin et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Allergic interstitial nephritis (AIN) is an underdiagnosed cause of acute kidney injury (AKI). Guidelines suggest that AIN should be suspected in a patient who presents with an elevated serum creatinine and a urinalysis that shows white cells, white cell casts, or eosinophiluria. Drug-induced AIN is suspected if AKI is temporally related to the initiation of a new drug. However, patients with bland sediment and normal urinalysis can also have AIN. Currently, a definitive diagnosis of AIN is made by renal biopsy which is invasive and fraught with risks such as bleeding, infection, and hematoma. Additionally, it is frequently unclear when a kidney biopsy should be undertaken. We describe a biopsy proven case of allergic interstitial nephritis which manifested on contrast enhanced Magnetic Resonance Imaging (MRI) as a striated nephrogram. Newer and more stable macrocyclic gadolinium contrast agents have a well-demonstrated safety profile. Additionally, in the presentation of AKI, gadolinium contrast agents are safe to administer in patients who demonstrate good urine output and a downtrending creatinine. We propose that the differential for a striated nephrogram may include AIN. In cases in which the suspicion for AIN is high, this diagnostic consideration may be further characterized by contrast enhanced MRI.