Journal of Postgraduate Medicine
 Open access journal indexed with Index Medicus & ISI's SCI  
Users online: 3772  
Home | Subscribe | Feedback | Login 
About Latest Articles Back-Issues Articlesmenu-bullet Search Instructions Online Submission Subscribe Etcetera Contact
 :: Next article
 :: Previous article 
 :: Table of Contents
 ::  Similar in PUBMED
 ::  Search Pubmed for
 ::  Search in Google Scholar for
 ::  Article in PDF (45 KB)
 ::  Citation Manager
 ::  Access Statistics
 ::  Reader Comments
 ::  Email Alert *
 ::  Add to My List *
* Registration required (free) 

  IN THIS Article
 ::  References
 ::  Article Figures

 Article Access Statistics
    PDF Downloaded134    
    Comments [Add]    
    Cited by others 3    

Recommend this journal


Year : 2008  |  Volume : 54  |  Issue : 2  |  Page : 170-171

Acute interstitial nephritis in association with polymyositis

1 Department of Internal Medicine, Christian Medical College and Hospital, Ludhiana, Punjab, India
2 Department of Nephrology, Christian Medical College and Hospital, Ludhiana, Punjab, India
3 Department of Pathology, Christian Medical College and Hospital, Ludhiana, Punjab, India

Correspondence Address:
P George
Department of Internal Medicine, Christian Medical College and Hospital, Ludhiana, Punjab
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0022-3859.40795

Rights and Permissions

How to cite this article:
Das J, George P, Pawar B, Calton N. Acute interstitial nephritis in association with polymyositis. J Postgrad Med 2008;54:170-1

How to cite this URL:
Das J, George P, Pawar B, Calton N. Acute interstitial nephritis in association with polymyositis. J Postgrad Med [serial online] 2008 [cited 2023 Jun 1];54:170-1. Available from:


Inflammatory myopathies are diseases in which muscles are damaged by endomysial and occasionally perivascular infiltration of inflammatory cells. The clinical syndrome with these pathological changes is termed polymyositis. Renal involvement in polymyositis is distinctly uncommon. [1]

A 39-year-old male presented with progressive weakness of upper and lower limbs for six months, worsening two months prior to admission. Proximal muscle weakness with sparing of extraocular and facial muscles was present. There was no history of skin rash, exposure to myotoxic drugs or toxins. Proximal muscle weakness was present on examination. No lymphadenopathy or uveitis was present.

Investigation showed elevated muscle enzymes with creatine kinase (CK) 12,980U/L, lactate dehydrogenase (LDH) 1600UL and aspartate amino transferase (AST) 198U/L. Renal and liver functions were normal. Muscle biopsy was suggestive of inflammatory myopathy and a diagnosis of acute polymyositis was made. He was initiated on oral prednisolone at 1mg/kg/day and discharged. Over the next three months an improvement in the levels of muscle enzymes was observed. Prednisolone was tapered to 0.5mg/kg/day and oral azathioprine 150mg was added once daily. Prednisolone was stopped after six months.

Seven months after discharge he was readmitted with fever and acute parotitis. Investigations showed leucocytosis and neutrophilia. His blood urea was 76mg/dl, serum creatinine 1.7mg/dl, serum calcium 7.8mg/dl and serum phosphorus 2.7mg/dl with normal potassium levels. Muscle enzymes were elevated (CK 575U/L, LDH 548U/L, AST 47U/L.) Urinalysis showed no eosinophiluria. The blood and urine cultures were sterile. There were no features to suggest sicca syndrome and the parotitis resolved with antibiotic. It was hence not investigated any further. No features of sarcoidosis were present.

The serum creatinine increased to 6.4mg/dl over the next three days and hemodialysis was initiated. He improved clinically but renal function failed to improve and a renal biopsy was performed.

Light microscopy was suggestive of acute tubulointerstitial nephritis with tubular injury [Figure - 1]. Immunofluorescence was negative for immunoglobulins and C3. Oral prednisolone was restarted at 1mg/kg/day and he was discharged with a serum creatinine of 2.7mg/dl. Renal function normalized on follow-up.

Acute tubular necrosis related to myoglobinemia and myoglobinuria is a well-recognized feature of acute rhabdomyolysis in polymyositis. [2] Mesangial proliferation is the commonest glomerular lesion in polymyositis and suggests a possible association between arthritis and glomerulonephritis. [3] Chronic glomerulonephritis has also been infrequently reported. [2] Association of acute interstitial nephritis (AIN) has not been described with polymyositis.

A study of 64 patients with neuromuscular disease on azathioprine reported toxicity with reversible leucopenia (22%), hepatotoxicity (9%) and a systemic reaction (12%). [4] Azathioprine hypersensitivity manifests with fever and gastrointestinal symptoms initially. Maculopapular rash, urticaria, vasculitis, erythema multiforme or erythema nodosum may occur. Hepatotoxicity and nephritis have also been reported. [5] This reaction is observed in patients early during treatment with azathioprine. This patient received azathioprine for more than six months and did not have any features to suggest a hypersensitivity reaction. Other medications taken by him were reviewed but no drug causing AIN was consumed. An association of AIN with polymyositis was thus made. The resolution of renal failure and improvement of myositis with corticosteroid treatment indicates the possibility of an immune pathophysiology of this association.

 :: References Top

1.Robert WJ, William PA. Renal disorders associated with systemic sclerosis, rheumatoid arthritis, sjogren's syndrome and polymyositis-dermatomyositis. In : Schrier RW, editor. Diseases of the kidney and urinary tract. 8 th ed. Lippincott, Williams and Wilkins: Philadelphia; 2007. p. 1713-4.  Back to cited text no. 1    
2.Yen TH, Lai PC, Chen CC, Hsueh S, Huang JY. Renal involvement in patients with polymyositis and dermatomyositis. Int J Clin Pract 2005;59:188-93.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Frost NA, Morand EF, Hall CL, Maddison PJ, Bhalla AK. Idiopathic polymyositis complicated by arthritis and mesangial proliferative glomerulonephritis: case report and review of the literature. Br J Rheumatol 1993;32:929-31.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Kissel JT, Levy RJ, Mendell JR, Griggs RC. Azathioprine toxicity in neuromuscular disease. Neurology 1986;36:35-9.  Back to cited text no. 4  [PUBMED]  
5.Knowles SR, Gutpta AK, Shear NH, Sauder D. Azathioprine hypersensitivity-like reactions: A case report and a review of the literature. Clin Exp Dermatol 1995;20:353-6.  Back to cited text no. 5    


  [Figure - 1]

This article has been cited by
1 Nephrotic Syndrome as an Extramuscular Manifestation of Anti-EJ Antibody-Positive Dermatomyositis: A Case Report and Review of the Literature
Syoko Tsubouchi, Takahiro Mizuuchi, Yusuke Yamamoto, Daiki Fujimori, Kayo Ishii, Mayu Tago, Eri Kato, Hiroaki Mori, Haeru Hayashi, Koichiro Tahara, Tetsuji Sawada, Gregory J. Tsay
Case Reports in Rheumatology. 2022; 2022: 1
[Pubmed] | [DOI]
2 Renal Involvement in Idiopathic Inflammatory Myopathies
David Cucchiari,Claudio Angelini
Clinical Reviews in Allergy & Immunology. 2015;
[Pubmed] | [DOI]
3 The Spectrum of Renal Involvement in Patients With Inflammatory Myopathies
Grégoire Couvrat-Desvergnes,Agathe Masseau,Olivier Benveniste,Alexandra Bruel,Baptiste Hervier,Jean-Marie Mussini,David Buob,Eric Hachulla,Philippe Rémy,Raymond Azar,Evelyne Mac Namara,Brigitte MacGregor,Laurent Daniel,Adeline Lacraz,Thomas De Broucker,Philippe Rouvier,Philippe Carli,Maurice Laville,Etienne Dantan,Mohamed Hamidou,Anne Moreau,Fadi Fakhouri
Medicine. 2014; 93(1): 33
[Pubmed] | [DOI]


Print this article  Email this article
Previous article Next article
Online since 12th February '04
© 2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
Published by Wolters Kluwer - Medknow