case_images: PMC4421347_01
case_images: (A) Pre-treatment granulomatous interstitial nephritis (H & E, low power), arrow demonstrating granuloma. (B) Pre-treatment granulomatous interstitial nephritis granuloma (H & E, high power). (C and D) Post-treatment with adalimumab showing an intact glomerulus with diabetic changes, marked tubular atrophy, minimal interstitial inflammation and complete disappearance of granulomas (H & E, low power).
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case_images: PMC4421347_01_sfn200fig1.jpg
case_images: F1
case_images: The biopsy consisted of at least seven glomeruli revealing granulomatous interstitial nephritis consistent with renal sarcoidosis with moderate-to-severe chronic tubulointerstitial disease, multiple granulomas along with hypertensive vasculopathy and diabetic glomerulosclerosis with diffuse and nodular lesions (Figure 1A and B). A repeat biopsy sampled ~17 glomeruli and revealed stable diabetic glomerulosclerosis, moderate chronic tubulointerstitial inflammation with complete resolution of interstitial epitheliod granulomas (Figure 1C and D).
case_images: Serum creatinine and daily protein excretion in a female with granulomatous interstitial nephritis who was treated with adalimumab weekly for 6 months.
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case_images: PMC4421347_01_sfn200fig2.jpg
case_images: F2
case_images: to 159 mumol/L (1.8 mg/dL) and her protein excretion declined to ~3.5 g in 24 h (Figure 2).