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Giant Cell Tubulitis with Tubular Basement Membrane Immune Deposits: A Report of Two Cases after Cardiac Valve Replacement Surgery

Anthony Chang^*, Carine J. Peutz-Kootstra, Jolanta Kowalewska^*, Christine M. Logar, Jeremy J. Gitomer, Connie L. Davis, Stuart J. Shankland, Charles E. Alpers^*, and Kelly D. Smith^*

Departments of ^* Pathology; Medicine, University of Washington Medical Center, Seattle, Washington; Department of Pathology, Academic Hospital Maastricht, Maastricht, the Netherlands; and Alaska Kidney Consultants, Anchorage, Alaska

Address correspondence to: Dr. Anthony Chang, University of Chicago Hospitals, Department of Pathology, 5841 S. Maryland Avenue, Chicago, IL 60637. Phone: 773-834-3426; Fax: 773-834-7644; E-mail: anthony.chang{at}uchospitals.edu

This paper presents two elderly patients who had normal baseline renal function and had stenotic valvular lesions secondary to rheumatic fever and underwent aortic valve replacements with mechanical valves. Both patients developed acute renal failure after cardiac valve replacement procedures. The renal biopsies revealed acute granulomatous tubulointerstitial nephritis. The unique histologic features were tubular basement membrane (TBM) immune complex deposition detected by both immunofluorescence and electron microscopy and prominent multinucleated giant cells surrounding intact TBM. The temporal relationship to the surgical procedure and the subsequent recovery of the patients’ renal functions upon therapy suggested that the renal failure may have been due to an allergic drug reaction from the perioperative exposure to unknown agents, such as prophylactic antibiotics and furosemide. The literature on TBM immune complex deposition was reviewed, and the pathophysiologic mechanisms that may account for the similarities between the clinicopathologic features of these two cases were examined. These two cases expand the histopathologic spectrum of previously described cases of putative drug-induced acute tubulointerstitial nephritis.

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				A. Chang, S. Hingorani, J. Kowalewska, M. E.D. Flowers, T. Aneja, K. D. Smith, S. M. Meehan, R. F. Nicosia, and C. E. Alpers Spectrum of Renal Pathology in Hematopoietic Cell Transplantation: A Series of 20 Patients and Review of the Literature Clin. J. Am. Soc. Nephrol., September 1, 2007; 2(5): 1014 - 1023. [Abstract] [Full Text] [PDF]