HLA Class II Display by Circulating T Lymphocytes in Nonsteroidal Anti-Inflammatory Nephritis Induced by Drugs

Yosuke Ogura, MD, Kidney Center, Toranomon Hospital, 2-2-2 Toranomon, Minatoku, Tokyo 105 (Japan) CD lib, and moreover, stained by 12 or 13 antibodies. Therefore, the renal interstitium was infiltrated by cytotoxic T cells expressing HLA class II antigen. Consequently, prednisolone treatment was started with 30 mg per day. After 2 weeks of prednisolone therapy, blood urea nitrogen and creatinine levels returned to normal, being 19 and Dear Sir, Nonsteroidal anti-inflammatory drugs (NSAIDS) have been reported increasingly as causes of renal dysfunction [1-3]. In spite of the abundant clinical data available to characterize the natural history of nephritis with or without nephrotic syndrome, there has been limited information concerning im-munopathogenic mechanisms [4]. Renal biopsies performed by several groups have demonstrated a predominance of cytotoxic T cells in the interstitium [5, 6], while some biopsies taken early in the acute phase have shown significant infiltration by helper T cells [7]. Even when the predominant lymphocyte subset expressed in the interstitium has varied among groups, it has been speculated that cellmediated immune mechanisms may be involved in the patho-genesis of NSAID-induced interstitial nephritis. We had a 56-year-old male manifesting an acute renal failure without the nephrotic syndrome. He had taken diclofenac sodium 200-300 mg daily in the past 4 weeks because of persistent shoulder pain. On admission, blood urea nitrogen was 36 mg/dl, and serum creatinine was 2.6 mg/dl. A first renal biopsy was performed in the 4th week of hospitalization (fig. 1) to determine the indication of steroid treatment for the persistent renal dysfunction. It revealed interstitial nephritis, and the lymphocyte subpopulations within the interstitial inflammatory infiltrates confirmed that, in good accordance with previous reports [5, 6], 90% of them were T cells with a CD4+/CD8+ ratio of 1:4. These CD 8+ cells were also positive to