Causes of Granulomatous Inflammation in Native and
Allograft Kidneys: Case Series from A Single Center and
A Review of the Literature

ARDA, Hayri Üstün; Yıldırım, Filiz; CAVDAR, CANER; Sarioglu, Sulen; SİFİL, AHMET AYKUT; OKTAN, MEHMET ASI; Unlu, Mehtat; UZUN, Özcan; Heybeli, Cihan; Celik, Ali; yildiz, serkan; DEMİR YÜKSEL, BERNA

doi:10.5146/tjpath.2021.01561

Causes of Granulomatous Inflammation in Native and Allograft Kidneys: Case Series from A Single Center and A Review of the Literature

Cihan HEYBELİ, (Muş Devlet Hastanesi, Nefroloji Bilim Dalı, Muş, Türkiye)

Berna Demir YÜKSEL, (Dokuz Eylül Üniversitesi Hastanesi, İç Hastalıkları Anabilim Dalı, İzmir, Türkiye)

Mehtat ÜNLÜ, (Dokuz Eylül Üniversitesi Hastanesi, Patoloji Anabilim Dalı, İzmir, Türkiye)

Sülen SARIOĞLU, (Dokuz Eylül Üniversitesi Hastanesi, Patoloji Anabilim Dalı, İzmir, Türkiye)

Mehmet Asi OKTAN, (Başkent Üniversitesi Hastanesi Nefroloji Anabilim Dalı, İzmir, Türkiye)

Ali ÇELİK, (Başkent Üniversitesi Hastanesi Nefroloji Anabilim Dalı, İzmir, Türkiye)

Hayri Üstün ARDA, (Dokuz Eylül Üniversite Hastanesi, Nefroloji Anabilim Dalı, İzmir, Türkiye)

Özcan UZUN, (Dokuz Eylül Üniversite Hastanesi, Nefroloji Anabilim Dalı, İzmir, Türkiye)

Filiz YILDIRIM, (Dokuz Eylül Üniversite Hastanesi, Nefroloji Anabilim Dalı, İzmir, Türkiye)

Caner ÇAVDAR, (Dokuz Eylül Üniversite Hastanesi, Nefroloji Anabilim Dalı, İzmir, Türkiye)

Aykut SİFİL, (Dokuz Eylül Üniversite Hastanesi, Nefroloji Anabilim Dalı, İzmir, Türkiye)

Serkan YILDIZ, (Medicana Hastanesi Nefroloji Anabilim Dalı, İzmir, Türkiye)

Diğer Yazarlar

Türk Patoloji Dergisi

5 0

Yıl: 2022 Cilt: 38 Sayı: 2 Sayfa Aralığı: 122 - 132 Metin Dili: İngilizce DOI: 10.5146/tjpath.2021.01561 İndeks Tarihi: 29-06-2022

Causes of Granulomatous Inflammation in Native and Allograft Kidneys: Case Series from A Single Center and A Review of the Literature

Öz:

Objective: Granulomatous interstitial nephritis is a rare finding, and etiology differs by geography. We aimed to investigate the distribution of causes of granuloma/granulomata in the kidney and renal survival of these patients in a tertiary care hospital in Western Turkey. Material and Method: Medical records of adults who underwent a kidney biopsy procedure in our institution between January 2000 and June 2019 were reviewed. Pathology reports were searched for biopsies where a granuloma was identified. Results: Nineteen of 1121 (1.7%) kidney biopsies included granuloma, 17 in native kidneys, and 2 in transplants. The majority of indications for native kidney biopsy was a rise in serum creatinine. Etiologies of granuloma included the following: pauci-immune vasculitis (n=11, 64.7%), tuberculosis (n=2, 11.8%), drug-induced (n=2, 11.8%), tubulointerstitial nephritis/uveitis (TINU) syndrome (n=1, 5.9%), and systemic-lupus erythematosus (n=1, 5.9%). Despite treatment, 6 of 11 (54.5%) patients with vasculitis developed end-stage kidney disease (ESKD) during the median follow-up of 16 months. Both of the patients with tuberculosis, and the patient with TINU syndrome developed ESKD months after the kidney biopsy, despite appropriate therapies. The only case with drug-induced granuloma and both cases with allograft kidney granuloma responded well to glucocorticoids, achieving a complete renal recovery. Conclusion: The majority of our series had granuloma in the kidney secondary to vasculitis and renal outcomes appear considerably unfavorable despite treatment, probably related to the primary diagnosis. Multicenter studies are needed to better determine the etiology and outcome of each granuloma etiology at different geographic locations.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Shah S, Carter-Monroe N, Atta MG. Granulomatous interstitial nephritis. Clin Kidney J. 2015;8:516-23.
2. O’Riordan E, Willert RP, Reeve R, Kalra PA, O’Donoghue DJ, Foley RN, Waldek S. Isolated sarcoid granulomatous interstitial nephritis: Review of five cases at one center. Clin Nephrol. 2001; 55:297-302.
3. Robson MG, Banerjee D, Hopster D, Cairns HS. Seven cases of granulomatous interstitial nephritis in the absence of extrarenal sarcoid. Nephrol Dial Transplant. 2003;18:280-4.
4. Tsukada H, Shimizu H, Kaname S. Bilateral nephromegaly due to isolated renal sarcoidosis. Clin Exp Nephrol. 2017;21:169-70.
5. Utas C, Dogukan A, Patiroglu TE, Oymak S, Oymak O. Granulomatous interstitial nephritis in extrapulmonary sarcoidosis. Clin Nephrol. 1999;51:252-4.
6. Timmermans SA, Christiaans MH, Abdul-Hamid MA, Stifft F, Damoiseaux JG, van Paassen P. Granulomatous interstitial nephritis and Crohn’s disease. Clin Kidney J. 2016;9:556-9.
7. Bitik B, Gonul, II, Haznedaroglu S, Goker B, Tufan A. Granulomatous interstitial nephritis associated with Primary Sjogren’s syndrome. Z Rheumatol. 2017;76:458-60.
8. Inoue T, Sato T, Okada H, Kayano H, Watanabe Y, Kikuta T, Tsuda M, Sueyoshi K, Takenaka T, Suzuki H. Granulomatous interstitial nephritis in chronic lymphocytic leukaemia. Nephrol Dial Transplant. 2010;25:4107-9.
9. Nasr SH, Shanafelt TD, Hanson CA, Fidler ME, Cornell LD, Sethi S, Chaffee KG, Morris J, Leung N. Granulomatous interstitial nephritis secondary to chronic lymphocytic leukemia/small lymphocytic lymphoma. Ann Diagn Pathol. 2015;19:130-6.
10. Nasr SH, Koscica J, Markowitz GS, D’Agati VD. Granulomatous interstitial nephritis. Am J Kidney Dis. 2003;41:714-9.
11. Ogura M, Kagami S, Nakao M, Kono M, Kanetsuna Y, Hosoya T. Fungal granulomatous interstitial nephritis presenting as acute kidney injury diagnosed by renal histology including PCR assay. Clin Kidney J. 2012;5:459-62.
12. Gupta P, Rana DS, Bhalla AK, Gupta A, Malik M, Gupta A, Bhargava V. Renal failure due to granulomatous interstitial nephritis in native and allograft renal biopsies: Experience from a tertiary care hospital. Ren Fail. 2014;36:1468-70.
13. Sampathkumar K, Sooraj YS, Mahaldar AR, Ramakrishnan M, Rajappannair A, Nalumakkal SV, Erode E. Granulomatous interstitial nephritis due to tuberculosis-a rare presentation. Saudi J Kidney Dis Transpl. 2009;20:842-5.
14. Enriquez R, Cabezuelo JB, Gonzalez C, Lacueva J, Teruel A, Fernandez J, Arenas MD. Granulomatous interstitial nephritis associated with hydrochlorothiazide/amiloride. Am J Nephrol. 1995;15:270-3.
15. Geevasinga N, Coleman PL, Roger SD. Rabeprazole-induced acute interstitial nephritis. Nephrology. (Carlton) 2005;10:7-9.
16. Nadri Q, Althaf MM. Granulomatous tubulointerstitial nephritis secondary to omeprazole. BMJ Case Rep. 2014;2014.
17. Jung K, Zeng X, Bilusic M. Nivolumab-associated acute glomerulonephritis: A case report and literature review. BMC Nephrol. 2016;17:188.
18. Schwarz A, Krause PH, Keller F, Offermann G, Mihatsch MJ. Granulomatous interstitial nephritis after nonsteroidal antiinflammatory drugs. Am J Nephrol. 1988;8:410-6.
19. Avgustin N, Kovac D, Kojc N, Mlinsek G, Lindic J. Acute granulomatous interstitial nephritis and acute rejection in a kidney transplant recipient after zoledronic acid therapy - a case report and review of the literature. Clin Nephrol. 2017;88:97-100.
20. Islam S, Dubigeon MP, Guenel J. Acute and reversible interstitial granulomatous nephropathy after treatment with captopril. Rev Med Interne. 1990;11:231-3.
21. Goli R, Mukku KK, Raju SB, Uppin MS. Acute Ciprofloxacin- Induced Crystal Nephropathy with Granulomatous Interstitial Nephritis. Indian J Nephrol. 2017;27:231-3.
22. Hong S, Valderrama E, Mattana J, Shah HH, Wagner JD, Esposito M, Singhal PC. Vancomycin-induced acute granulomatous interstitial nephritis: Therapeutic options. Am J Med Sci. 2007; 334:296-300.
23. Korsten P, Sweiss NJ, Nagorsnik U, Niewold TB, Grone HJ, Gross O, Muller GA. Drug-induced granulomatous interstitial nephritis in a patient with ankylosing spondylitis during therapy with adalimumab. Am J Kidney Dis. 2010;56:e17-21.
24. Sandys V, Moloney B, Lane L, Qazi J, Doyle B, Barry M, Leavey S, Conlon P. Granulomatous interstitial nephritis secondary to adalimumab therapy. Clin Kidney J. 2018;11:219-21.
25. Borrego Utiel FJ, Luque Barona R, Perez Del Barrio P, Borrego Hinojosa J, Ramirez Tortosa C. Acute Kidney Injury due to granulomatous interstitial nephritis induced by tramadol administration. Nefrologia. 2018;38:227-8.
26. Chu GJ, Henderson C, Evans L, Howlin K, Murad A. Chronic granulomatous interstitial nephritis and urothelial metaplasia associated with ritonavir-boosted atazanavir: A case study and literature review. Pathology. 2018;50:565-8.
27. Varghese V, Rodriguez R, Self S, Velez JCQ. Atazanavir Crystal- Induced Chronic Granulomatous Interstitial Nephritis. Kidney Int Rep. 2020;5:1106-10.
28. Bottlaender L, Breton AL, de Laforcade L, Dijoud F, Thomas L, Dalle S. Acute interstitial nephritis after sequential ipilumumab - nivolumab therapy of metastatic melanoma. J Immunother Cancer. 2017;5:57.
29. Oliveira B, Jayawardene S, Shah S. Single-centre experience of granulomatous interstitial nephritis-time for a new approach? Clin Kidney J. 2017;10:249-54.
30. Shah KK, Pritt BS, Alexander MP. Histopathologic review of granulomatous inflammation. J Clin Tuberc Other Mycobact Dis. 2017;7:1-12.
31. Bijol V, Mendez GP, Nose V, Rennke HG. Granulomatous interstitial nephritis: A clinicopathologic study of 46 cases from a single institution. Int J Surg Pathol. 2006;14:57-63.
32. Joss N, Morris S, Young B, Geddes C. Granulomatous interstitial nephritis. Clin J Am Soc Nephrol. 2007;2:222-30.
33. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2:1-138.
34. Jennette JC. Rapidly progressive crescentic glomerulonephritis. Kidney Int. 2003;63:1164-77.
35. Grossfeld GD, Wolf JS Jr, Litwan MS, Hricak H, Shuler CL, Agerter DC, Carroll PR. Asymptomatic microscopic hematuria in adults: Summary of the AUA best practice policy recommendations. Am Fam Physician. 2001;63:1145-54.
36. Levey AS, de Jong PE, Coresh J, El Nahas M, Astor BC, Matsushita K, Gansevoort RT, Kasiske BL, Eckardt KU. The definition, classification, and prognosis of chronic kidney disease: A KDIGO Controversies Conference report. Kidney Int. 2011;80:17-28.
37. Cortazar FB, Kibbelaar ZA, Glezerman IG, Abudayyeh A, Mamlouk O, Motwani SS, Murakami N, Herrmann SM, Manohar S, Shirali AC, Kitchlu A, Shirazian S, Assal A, Vijayan A, Renaghan AD, Ortiz-Melo DI, Rangarajan S, Malik AB, Hogan JJ, Dinh AR, Shin DS, Marrone KA, Mithani Z, Johnson DB, Hosseini A, Uprety D, Sharma S, Gupta S, Reynolds KL, Sise ME, Leaf DE. Clinical Features and Outcomes of Immune Checkpoint Inhibitor-Associated AKI: A Multicenter Study. J Am Soc Nephrol. 2020;31:435-46.
38. Zammouri A, Barbouch S, Najjar M, Aoudia R, Jaziri F, Kaaroud H, Hedri H, Abderrahim E, Goucha R, Hamida FB, Harzallah A, Abdallah TB. Tubulointerstitial nephritis due to sarcoidosis: Clinical, laboratory, and histological features and outcome in a cohort of 24 patients. Saudi J Kidney Dis Transpl. 2019;30:1276- 84.
39. Zajjari Y, Azizi M, Bahadi A, Montasser D, Aatif T, Alayoud A, El Kabbaj D. Granulomatous interstitial nephritis in the military hospital of Morocco: Causes and outcomes. Saudi J Kidney Dis Transpl. 2020;31:589-96.
40. Bajema IM, Hagen EC, van der Woude FJ, Bruijn JA. Wegener’s granulomatosis: A meta-analysis of 349 literary case reports. J Lab Clin Med. 1997;129:17-22.
41. Unlu M, Kiremitci S, Ensari A, Ozluk Y, Kilicaslan I, Ozdemir BH, Ates D, Ertoy Baydar D, Gonul, II, Memis L, Sarsik B, Sen S, Akkaya B, Orhan D, Gonlusen G, Ellidokuz H, Ada S, Cavdar C, Akagun T, Kamali S, Aksu K, Yazisiz V, Paydas S, Soylu A, Sarioglu S. Pauci-immune necrotizing crescentic glomerulonephritis with crescentic and full moon extracapillary proliferation: Clinicopathologic correlation and follow-up study. Pathol Res Pract. 2013;209:75-82.
42. Eastwood JB, Corbishley CM, Grange JM. Tuberculosis and the kidney. J Am Soc Nephrol. 2001;12:1307-14.
43. Agrawal V, Kaul A, Prasad N, Sharma K, Agarwal V. Etiological diagnosis of granulomatous tubulointerstitial nephritis in the tropics. Clin Kidney J. 2015;8:524-30.
44. Larsen CP, Moreira RK, Hennigar RA, Bijol V. Kidney biopsy findings in a patient with fever, bilateral pulmonary infiltrates, and acute renal failure. Am J Kidney Dis. 2008;51:524-9.
45. Davidson B, Nel D, Jones ESW, Manning K, Spies R, Bohmer R, Omar A, Ash S, Wearne N. Granulomatous interstitial nephritis on renal biopsy in human immunodeficiency virus positive patients: Prevalence and causes in Cape Town, South Africa. Nephrology. (Carlton) 2019;24:681-8.
46. Karmakar S, Basu K, Sengupta M, Sircar D, Roychowdhury A. Granulomatous Interstitial Nephritis - A Series of Six Cases. Indian J Nephrol. 2020;30:26-8.
47. Farris AB, Ellis CL, Rogers TE, Chon WJ, Chang A, Meehan SM. Renal allograft granulomatous interstitial nephritis: Observations of an uncommon injury pattern in 22 transplant recipients. Clin Kidney J. 2017;10:240-8.
48. Vargas F, Gedalia A, Craver RD, Matti Vehaskari V. Recurrence of granulomatous interstitial nephritis in transplanted kidney. Pediatr Transplant. 2010;14:e54-7.
49. Teranishi J, Hattori Y, Mochizuki T, Kawahara T, Makiyama K, Uemura H. Effective Treatment With Everolimus for Recurrent Granulomatous Interstitial Nephritis in a Renal Transplant Recipient: A Case Report. Transplant Proc. 2016;48:946-8.
50. Murtaza A, Ali H, Nair B, Ahmed AK. Recurrence of Tubulointerstitial Nephritis Without Uveitis, in a Patient with Previous Tubulointerstitial Nephritis and Uveitis Syndrome After Transplant. Exp Clin Transplant. 2018;16:216-8.
51. Onyekpe I, Shenoy M, Denley H, Riad H, Webb NJ. Recurrent tubulointerstitial nephritis and uveitis syndrome in a renal transplant recipient. Nephrol Dial Transplant. 2011;26:3060-2.
52. Khaira A, Bagchi S, Sharma A, Mukund A, Mahajan S, Bhowmik D, Dinda AK, Agarwal SK. Renal allograft tuberculosis: Report of three cases and review of literature. Clin Exp Nephrol. 2009;13:392-6.
39. Zajjari Y, Azizi M, Bahadi A, Montasser D, Aatif T, Alayoud A, El Kabbaj D. Granulomatous interstitial nephritis in the military hospital of Morocco: Causes and outcomes. Saudi J Kidney Dis Transpl. 2020;31:589-96.
40. Bajema IM, Hagen EC, van der Woude FJ, Bruijn JA. Wegener’s granulomatosis: A meta-analysis of 349 literary case reports. J Lab Clin Med. 1997;129:17-22.
41. Unlu M, Kiremitci S, Ensari A, Ozluk Y, Kilicaslan I, Ozdemir BH, Ates D, Ertoy Baydar D, Gonul, II, Memis L, Sarsik B, Sen S, Akkaya B, Orhan D, Gonlusen G, Ellidokuz H, Ada S, Cavdar C, Akagun T, Kamali S, Aksu K, Yazisiz V, Paydas S, Soylu A, Sarioglu S. Pauci-immune necrotizing crescentic glomerulonephritis with crescentic and full moon extracapillary proliferation: Clinicopathologic correlation and follow-up study. Pathol Res Pract. 2013;209:75-82.
42. Eastwood JB, Corbishley CM, Grange JM. Tuberculosis and the kidney. J Am Soc Nephrol. 2001;12:1307-14.
43. Agrawal V, Kaul A, Prasad N, Sharma K, Agarwal V. Etiological diagnosis of granulomatous tubulointerstitial nephritis in the tropics. Clin Kidney J. 2015;8:524-30.
44. Larsen CP, Moreira RK, Hennigar RA, Bijol V. Kidney biopsy findings in a patient with fever, bilateral pulmonary infiltrates, and acute renal failure. Am J Kidney Dis. 2008;51:524-9.
45. Davidson B, Nel D, Jones ESW, Manning K, Spies R, Bohmer R, Omar A, Ash S, Wearne N. Granulomatous interstitial nephritis on renal biopsy in human immunodeficiency virus positive patients: Prevalence and causes in Cape Town, South Africa. Nephrology. (Carlton) 2019;24:681-8.
46. Karmakar S, Basu K, Sengupta M, Sircar D, Roychowdhury A. Granulomatous Interstitial Nephritis - A Series of Six Cases. Indian J Nephrol. 2020;30:26-8.
47. Farris AB, Ellis CL, Rogers TE, Chon WJ, Chang A, Meehan SM. Renal allograft granulomatous interstitial nephritis: Observations of an uncommon injury pattern in 22 transplant recipients. Clin Kidney J. 2017;10:240-8.
48. Vargas F, Gedalia A, Craver RD, Matti Vehaskari V. Recurrence of granulomatous interstitial nephritis in transplanted kidney. Pediatr Transplant. 2010;14:e54-7.
49. Teranishi J, Hattori Y, Mochizuki T, Kawahara T, Makiyama K, Uemura H. Effective Treatment With Everolimus for Recurrent Granulomatous Interstitial Nephritis in a Renal Transplant Recipient: A Case Report. Transplant Proc. 2016;48:946-8.
50. Murtaza A, Ali H, Nair B, Ahmed AK. Recurrence of Tubulointerstitial Nephritis Without Uveitis, in a Patient with Previous Tubulointerstitial Nephritis and Uveitis Syndrome After Transplant. Exp Clin Transplant. 2018;16:216-8.
51. Onyekpe I, Shenoy M, Denley H, Riad H, Webb NJ. Recurrent tubulointerstitial nephritis and uveitis syndrome in a renal transplant recipient. Nephrol Dial Transplant. 2011;26:3060-2.
52. Khaira A, Bagchi S, Sharma A, Mukund A, Mahajan S, Bhowmik D, Dinda AK, Agarwal SK. Renal allograft tuberculosis: Report of three cases and review of literature. Clin Exp Nephrol. 2009;13:392-6.
53. Javaud N, Belenfant X, Stirnemann J, Laederich J, Ziol M, Callard P, Ronco P, Rondeau E, Fain O. Renal granulomatoses: A retrospective study of 40 cases and review of the literature. Medicine. (Baltimore) 2007;86:170-80.
54. Mignon F, Mery JP, Mougenot B, Ronco P, Roland J, Morel- Maroger L. Granulomatous interstitial nephritis. Adv Nephrol Necker Hosp. 1984;13:219-45.
55. Naidu GD, Ram R, Swarnalatha G, Uppin M, Prayaga AK, Dakshinamurty KV. Granulomatous interstitial nephritis: Our experience of 14 patients. Indian J Nephrol. 2013;23:415-8. 56. Viero RM, Cavallo T: Granulomatous interstitial nephritis. Hum Pathol. 1995;26:1347-53.
57. Alsaad KO, Tobar A, Belanger E, Ahmad M, Cattran DC, Herzenberg AM. Late-onset acute haemorrhagic necrotizing granulomatous adenovirus tubulointerstitial nephritis in a renal allograft. Nephrol Dial Transplant. 2007;22:1257-60.
58. al-Sulaiman MH, Dhar JM, al-Hasani MK, Haleem A, al-Khader A. Tuberculous interstitial nephritis after kidney transplantation. Transplantation. 1990;50:162-4.
59. Asim M, Chong-Lopez A, Nickeleit V. Adenovirus infection of a renal allograft. Am J Kidney Dis. 2003;41:696-701.
60. Aouizerate J, Matignon M, Kamar N, Thervet E, Randoux C, Moulin B, Raffray L, Buchler M, Villar E, Mahevas M, Desvaux D, Dahan K, Diet C, Audard V, Lang P, Grimbert P. Renal transplantation in patients with sarcoidosis: A French multicenter study. Clin J Am Soc Nephrol. 2010;5:2101-8.
61. Baden LR, Digumarthy SR, Guimaraes AS, Branda JA. Case records of the Massachusetts General Hospital. Case 35- 2009. A 60-year-old male renal-transplant recipient with renal insufficiency, diabetic ketoacidosis, and mental-status changes. N Engl J Med. 2009;361:1980-9.
62. Bagnasco SM, Subramanian AK, Desai NM. Fungal infection presenting as giant cell tubulointerstitial nephritis in kidney allograft. Transpl Infect Dis. 2012;14:288-91.
63. Barraclough K, Oliver K, Playford EG, Preston J, Campbell S, Johnson DW, Hawley C, Mudge D, van Eps C, Isbel N. Lifethreatening adenovirus infection in a kidney transplant recipient. NDT Plus. 2009;2:250-3.
64. Brown JH, Jos V, Newstead CG, Lawler W. Sarcoid-like granulomata in a renal transplant. Nephrol Dial Transplant. 1992;7:173.
65. Gaspert A, Luthi B, Mueller NJ, Bossart W, Heim A, Wuthrich RP, Fehr T. Subacute allograft failure with dysuria and hematuria in a kidney transplant recipient. Am J Kidney Dis. 2009;54:154-8.
66. Gonçalves AR, Caetano MA, Paula FJ, Ianhez LE, Saldanha LB, Sabbaga E. Tuberculous interstitial granulomatous nephritis in renal transplants: Report of three cases. Transplant Proc. 1992;24:1911.
67. Hatlen T, Mroch H, Tuttle K, Ojogho O, Rooney M, Desmond S, Bani-Hani S. Disseminated Adenovirus Nephritis After Kidney Transplantation. Kidney Int Rep. 2018;3:19-23.
68. Hotta K, Fukasawa Y, Sasaki H, Seki T, Togashi M, Harada H. Granulomatous tubulointerstitial nephritis in a renal allograft: Three cases report and review of literature. Clin Transplant. 2012;26 Suppl 24:70-5.
69. Josephson MA, Chiu MY, Woodle ES, Thistlethwaite JR, Haas M. Drug-induced acute interstitial nephritis in renal allografts: Histopathologic features and clinical course in six patients. Am J Kidney Dis. 1999;34:540-8.
70. Kukura S, Viklicky O, Lacha J, Voska L, Honsova E, Teplan V. Recurrence of sarcoidosis in renal allograft during pregnancy. Nephrol Dial Transplant. 2004;19:1640-2.
71. Lachiewicz AM, Cianciolo R, Miller MB, Derebail VK. Adenovirus causing fever, upper respiratory infection, and allograft nephritis complicated by persistent asymptomatic viremia. Transpl Infect Dis. 2014;16:648-52.
72. Lapasia JB, Kambham N, Busque S, Tan JC. Renal allograft granulomas in the early post-transplant period. NDT Plus. 2010;3:397-401.
73. Lorimer I, Botha J, Pontin AR, Pascoe MD, Kahn D. Tuberculosis isolated to the renal allograft. Transpl Infect Dis. 1999;1:83-6. 74. Meehan SM, Josephson MA, Haas M. Granulomatous tubulointerstitial nephritis in the renal allograft. Am J Kidney Dis. 2000;36:E27.
75. Ozdemir BH, Sar A, Uyar P, Suren D, Demirhan B, Haberal M. Posttransplant tubulointerstitial nephritis: Clinicopathological correlation. Transplant Proc. 2006;38:466-9.
76. Parasuraman R, Zhang PL, Samarapungavan D, Rocher L, Koffron A. Severe necrotizing adenovirus tubulointerstitial nephritis in a kidney transplant recipient. Case Rep Transplant. 2013;2013:969186.
77. Park UJ, Hyun SK, Kim HT, Cho WH, Han SY. Successful treatment of disseminated adenovirus infection with ribavirin and intravenous immunoglobulin in an adult renal transplant recipient: A case report. Transplant Proc. 2015;47:791-3.
78. Shen SY, Hall-Craggs M, Posner JN, Shabazz B. Recurrent sarcoid granulomatous nephritis and reactive tuberculin skin test in a renal transplant recipient. Am J Med. 1986;80:699-702.
79. Storsley L, Gibson IW. Adenovirus interstitial nephritis and rejection in an allograft. J Am Soc Nephrol. 2011;22:1423-7.
80. Sujeet K, Vasudev B, Desai P, Bellizzi J, Novoa-Takara L, He C, El-Meanawy A. Acute kidney injury requiring dialysis secondary to adenovirus nephritis in renal transplant recipient. Transpl Infect Dis. 2011;13:174-7.
81. Tse KC, Chan TM, Wong SS, Chan KW, Lam MF, Chan KH, Li FK, Choy BY, Lai KN. Granulomatous interstitial nephritis of the allograft kidney associated with rhodococcal pulmonary infection. Nephrol Dial Transplant. 2004;19:486-90.
82. Varma MC, Kushner YB, Ko DS, Kawai T, Martins PN, Kaur P, Markmann JF, Kotton CN. Early onset adenovirus infection after simultaneous kidney-pancreas transplant. Am J Transplant. 2011;11:623-7.
83. Veer M, Abdulmassih R, Como J, Min Z, Bhanot N. Adenoviral nephritis in a renal transplant recipient: Case report and literature review. Transpl Infect Dis. 2017;19.
84. Zhang Y, Ahmed H, Haririan A, Ugarte R, Papadimitriou JC, Drachenberg CB. Granulomatous inflammation in BK polyomavirus-associated nephropathy. Transpl Infect Dis. 2018;20:e12939.

APA	Heybeli C, DEMİR YÜKSEL B, Unlu M, Sarioglu S, OKTAN M, Celik A, ARDA H, UZUN Ö, Yıldırım F, CAVDAR C, SİFİL A, yildiz s (2022). Causes of Granulomatous Inflammation in Native and Allograft Kidneys: Case Series from A Single Center and A Review of the Literature. , 122 - 132. 10.5146/tjpath.2021.01561
Chicago	Heybeli Cihan,DEMİR YÜKSEL BERNA,Unlu Mehtat,Sarioglu Sulen,OKTAN MEHMET ASI,Celik Ali,ARDA Hayri Üstün,UZUN Özcan,Yıldırım Filiz,CAVDAR CANER,SİFİL AHMET AYKUT,yildiz serkan Causes of Granulomatous Inflammation in Native and Allograft Kidneys: Case Series from A Single Center and A Review of the Literature. (2022): 122 - 132. 10.5146/tjpath.2021.01561
MLA	Heybeli Cihan,DEMİR YÜKSEL BERNA,Unlu Mehtat,Sarioglu Sulen,OKTAN MEHMET ASI,Celik Ali,ARDA Hayri Üstün,UZUN Özcan,Yıldırım Filiz,CAVDAR CANER,SİFİL AHMET AYKUT,yildiz serkan Causes of Granulomatous Inflammation in Native and Allograft Kidneys: Case Series from A Single Center and A Review of the Literature. , 2022, ss.122 - 132. 10.5146/tjpath.2021.01561
AMA	Heybeli C,DEMİR YÜKSEL B,Unlu M,Sarioglu S,OKTAN M,Celik A,ARDA H,UZUN Ö,Yıldırım F,CAVDAR C,SİFİL A,yildiz s Causes of Granulomatous Inflammation in Native and Allograft Kidneys: Case Series from A Single Center and A Review of the Literature. . 2022; 122 - 132. 10.5146/tjpath.2021.01561
Vancouver	Heybeli C,DEMİR YÜKSEL B,Unlu M,Sarioglu S,OKTAN M,Celik A,ARDA H,UZUN Ö,Yıldırım F,CAVDAR C,SİFİL A,yildiz s Causes of Granulomatous Inflammation in Native and Allograft Kidneys: Case Series from A Single Center and A Review of the Literature. . 2022; 122 - 132. 10.5146/tjpath.2021.01561
IEEE	Heybeli C,DEMİR YÜKSEL B,Unlu M,Sarioglu S,OKTAN M,Celik A,ARDA H,UZUN Ö,Yıldırım F,CAVDAR C,SİFİL A,yildiz s "Causes of Granulomatous Inflammation in Native and Allograft Kidneys: Case Series from A Single Center and A Review of the Literature." , ss.122 - 132, 2022. 10.5146/tjpath.2021.01561
ISNAD	Heybeli, Cihan vd. "Causes of Granulomatous Inflammation in Native and Allograft Kidneys: Case Series from A Single Center and A Review of the Literature". (2022), 122-132. https://doi.org/10.5146/tjpath.2021.01561

APA	Heybeli C, DEMİR YÜKSEL B, Unlu M, Sarioglu S, OKTAN M, Celik A, ARDA H, UZUN Ö, Yıldırım F, CAVDAR C, SİFİL A, yildiz s (2022). Causes of Granulomatous Inflammation in Native and Allograft Kidneys: Case Series from A Single Center and A Review of the Literature. Türk Patoloji Dergisi, 38(2), 122 - 132. 10.5146/tjpath.2021.01561
Chicago	Heybeli Cihan,DEMİR YÜKSEL BERNA,Unlu Mehtat,Sarioglu Sulen,OKTAN MEHMET ASI,Celik Ali,ARDA Hayri Üstün,UZUN Özcan,Yıldırım Filiz,CAVDAR CANER,SİFİL AHMET AYKUT,yildiz serkan Causes of Granulomatous Inflammation in Native and Allograft Kidneys: Case Series from A Single Center and A Review of the Literature. Türk Patoloji Dergisi 38, no.2 (2022): 122 - 132. 10.5146/tjpath.2021.01561
MLA	Heybeli Cihan,DEMİR YÜKSEL BERNA,Unlu Mehtat,Sarioglu Sulen,OKTAN MEHMET ASI,Celik Ali,ARDA Hayri Üstün,UZUN Özcan,Yıldırım Filiz,CAVDAR CANER,SİFİL AHMET AYKUT,yildiz serkan Causes of Granulomatous Inflammation in Native and Allograft Kidneys: Case Series from A Single Center and A Review of the Literature. Türk Patoloji Dergisi, vol.38, no.2, 2022, ss.122 - 132. 10.5146/tjpath.2021.01561
AMA	Heybeli C,DEMİR YÜKSEL B,Unlu M,Sarioglu S,OKTAN M,Celik A,ARDA H,UZUN Ö,Yıldırım F,CAVDAR C,SİFİL A,yildiz s Causes of Granulomatous Inflammation in Native and Allograft Kidneys: Case Series from A Single Center and A Review of the Literature. Türk Patoloji Dergisi. 2022; 38(2): 122 - 132. 10.5146/tjpath.2021.01561
Vancouver	Heybeli C,DEMİR YÜKSEL B,Unlu M,Sarioglu S,OKTAN M,Celik A,ARDA H,UZUN Ö,Yıldırım F,CAVDAR C,SİFİL A,yildiz s Causes of Granulomatous Inflammation in Native and Allograft Kidneys: Case Series from A Single Center and A Review of the Literature. Türk Patoloji Dergisi. 2022; 38(2): 122 - 132. 10.5146/tjpath.2021.01561
IEEE	Heybeli C,DEMİR YÜKSEL B,Unlu M,Sarioglu S,OKTAN M,Celik A,ARDA H,UZUN Ö,Yıldırım F,CAVDAR C,SİFİL A,yildiz s "Causes of Granulomatous Inflammation in Native and Allograft Kidneys: Case Series from A Single Center and A Review of the Literature." Türk Patoloji Dergisi, 38, ss.122 - 132, 2022. 10.5146/tjpath.2021.01561
ISNAD	Heybeli, Cihan vd. "Causes of Granulomatous Inflammation in Native and Allograft Kidneys: Case Series from A Single Center and A Review of the Literature". Türk Patoloji Dergisi 38/2 (2022), 122-132. https://doi.org/10.5146/tjpath.2021.01561