NSAID-Induced Acute Interstitial Nephritis Concurrent With IgA Vasculitis: A Case-Based Systematic Review.

Authors

Carmela Caputo, Concetto Sessa, Vittorio Serio, Federica Baciga, Luigi Annicchiarico Petruzzelli, Bruno Minale, Walter Morale, Alessandro Mantovani, Antonio Granata, Louise Oni, Matko Marlais, Gabriele Malgieri, Rukshana Shroff, Yuri Battaglia

Published in

Kidney medicine. Volume 8. Issue 9. Pages 101462. Epub Jul 10, 2026.

Abstract

Overlap between acute interstitial nephritis (AIN) and glomerulonephritis is uncommon and diagnostically challenging. We present the first pediatric case of clinically diagnosed immunoglobulin A vasculitis nephritis (IgAV-N) concurrent with nonsteroidal anti-inflammatory drug (NSAID)-induced AIN. A 14-year-old boy was hospitalized for recurrent gastroenteritis, purpura, and arthralgia treated with ibuprofen. After 5 days, he developed stage 3 acute kidney injury, subnephrotic proteinuria, hypertension, and oligoanuria. Kidney biopsy showed mild to moderate interstitial inflammation with tubulitis; immunofluorescence was negative for glomerular IgA, with nonspecific tubular C3 staining. After NSAID discontinuation, 10 dialysis sessions, and corticosteroids, kidney function recovered completely within 3 months. To support the clinical lesson highlighted by our case, we conducted a systematic review of biopsy-confirmed AIN-glomerulonephritis overlap. PubMed, Scopus, Web of Science, and Google Scholar were searched for biopsy-confirmed AIN with concurrent glomerulonephritis. Clinical features, etiologies, treatments, and outcomes were extracted. Systematic review identified 8 studies (12 patients). Drug-related AIN predominated (9 of 12), followed by infection (2 of 12) and autoimmune disease (1 of 12). Nephrotic-range proteinuria was described in 6, hematuria in 8, and hypersensitivity findings in 7 of the 12 patients. Complete recovery occurred in 7 and partial recovery in 3 patients, and dialysis was required in 2 of the 12 patients. NSAID-induced AIN concurrent with IgA vasculitis nephritis should be suspected in atypical acute kidney injury.

PMID:
42668581
Bibliographic data and abstract were imported from PubMed on 30 Aug 2026.

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