A Case of Acetaminophen-Associated Acute Interstitial Nephritis

Case Report

Austin J Nephrol Hypertens. 2016; 3(2): 1061.

A Case of Acetaminophen-Associated Acute Interstitial Nephritis

Nakamura H¹*, Makino M², Anayama M¹, Makino Y¹, Tamura K¹ and Nagasawa M¹

¹Department of Nephrology, Shinonoi General Hospital, Japan

²Department of Pathology, Shinonoi General Hospital, Japan

*Corresponding author: Hironori Nakamura, Department of Nephrology, Shinonoi General Hospital, 666-1 Ai Shinonoi, Nagano 388-8004, Japan

Received: September 28, 2016; Accepted: October 21, 2016; Published: October 24, 2016


Few cases of acute interstitial nephritis associated with a therapeutic acetaminophen dose have been reported. A 33-year-old man developed an acute kidney injury after treatment with acetaminophen for fever. Rash, lymphadenopathy, petechiae, and arthralgia were not observed. Urinalysis indicated the presence of white blood cell casts, and computed tomography revealed bilateral kidney enlargement. Renal biopsy revealed massive infiltration of interstitial inflammatory cells and tubulitis. Following an extremely strong result for acetaminophen in drug lymphocyte stimulation tests, the patient was diagnosed with acetaminophen-associated acute interstitial nephritis. Therefore, acetaminophen should be considered an etiological agent of acute interstitial nephritis.

Keywords: Acute interstitial nephritis; Acetaminophen; Drug lymphocyte stimulation tests


AIN: Acute Interstitial Nephritis; AKI: Acute Kidney Injury; u-NAG: urinary N-acetyl-β-D-glucosaminidase; β2MG: beta 2 Microglobulin; Ig: Immunoglobulin; PAS: Periodic Acid-Schiff; DLST: Drug Lymphocyte Stimulation Test; cpm: counts per minute; SI: Stimulation Index; TINU: Tubulointerstitial Nephritis and Uveitis


Cases of renal failure related to drug-induced acute interstitial nephritis (AIN) are increasingly being reported in current medical practice. Although any drug can theoretically induce AIN, most cases of drug-induced AIN are attributed to antimicrobial and nonsteroidal anti-inflammatory drugs. Approximately 1%–2% of affected adult patients present with acetaminophen overdose-induced acute kidney injury (AKI) [1]. However, cases of AKI in patients treated with therapeutic doses of acetaminophen are rarely reported, particularly among adult populations [2,3]. We present here a rare case of AIN and AKI may be associated with a therapeutic dose of acetaminophen, which is considered relatively safe for renal health.

Case Presentation

In late February 2016, a 33-year-old man presented with fever and dry cough and was treated for 1 week with 500 mg of acetaminophen thrice per day, 50 mg of sitafloxacin twice per day, and 60 mg of loxoprofen sodium as needed. Seventeen days after the patient started to take medicines, the patient developed nausea and renal dysfunction and was referred and admitted to our hospital the next day for further study. At admission, his blood pressure was 142/82 mmHg and body temperature was 37.4°C. There was no evidence of rash, superficial lymphadenopathy, petechiae, or arthralgia.

Laboratory data including complete blood cell counts, common serum chemistry and immunological findings on admission are shown in Table1. Urinalysis revealed a gravity of 1.016, pH of 6.0, protein of 1+ (0.26 g/gCr), occult blood and glucose negativity, white blood cell casts, hematuria of 1–4, and 10–19 white blood cells per high-power field, with urinary N-acetyl-β-D-glucosaminidase (u-NAG) and beta 2 microglobulin (β2MG) levels of 27.3 IU/L and 19510 μg/L, respectively. Venous blood gas analysis indicated a pH of 7.37, pCO2 of 47 mmHg, and HCO3 of 26.7 mEq/L.