Acute tubulointerstitial nephritis associated with celecoxib.

Four days later (after 3 weeks of complete anuria) diuresis started to resume. Urinalysis revealed proteinuria (4.12 g/24 h), lambda light chains (2.41 g/l) and microhaematuria. Subsequently, complement normalized and urinalysis became negative. Creatinine dropped to 106mmol/l and no paraprotein was detectable in neither serum nor urine. In conclusion, this report describes one of the oldest patients with ITG. ITG has been associated with haematologic malignancies, hepatitis C, cryoglobulinaemia or autoimmune disease [1–3]. All these were excluded. The presentation by acute renal failure with an improvement of renal fuction after therapy has not been reported previously. Patients with ITG usually present with proteinuria, microhaematuria, hypertension and renal insufficiency, that may gradually progress to end-stage renal disease [3,5]. In this case the illness started with dehydration. However, there were no features of acute tubular necrosis in the biopsy, and we assume that initial dehydration was a cause of accelerated fibrillogenesis. Successful treatment with steroid pulse therapy has been reported previously [4,6]. Our patient showed a dramatic response to pulse steroids, although a lower continuous dose was ineffective. At present, 13 months after the diagnosis, the patient is still in complete remission.