Long-term outcome in biopsy-proven acute interstitial nephritis treated with steroids

Abstract

Background: There are no prospective randomized controlled trials describing the outcome of acute interstitial nephritis (AIN) treated with steroids, and retrospective studies are limited. Methods: We identified adult patients with a diagnosis of AIN without glomerular pathology over a 14-year period. Treated patients all received oral prednisolone and three also recieved IV methylprednisolone. Data were collected retrospectively on estimated glomerular filtration rate (eGFR), change in eGFR from time of biopsy, dependence on renal replacement therapy (RRT) and mortality, and outcomes were analysed according to the treatment prescribed. Results: A total of 187 eligible patients with AIN were identified and 158 were treated with steroids. There was no difference in median eGFR or dependence on RRT at the time of biopsy. Steroid-treated patients had significantly higher eGFR at all time points post-biopsy up to 24 months, when median eGFR was 43 mL/min in the steroid-treated group and 24 mL/min in the untreated group (P = 0.01). Fewer patients in the steroid-treated group were dialysis dependent by 6 months (3.2% versus 20.6%, P = 0.0022) and 24 months (5.1% versus 24.1%, P = 0.0019). Conclusions: This large retrospective study suggests a benefit of steroids in treatment of AIN with greater improvement in eGFR and fewer patients progressing to end-stage renal disease.

Effectiveness of corticosteroid compared with non‐corticosteroid therapy for the treatment of drug‐induced acute interstitial nephritis: a systematic review

“…Four of these studies did not find a significant difference in change of serum creatinine levels between the corticosteroid and the non‐corticosteroid groups, while two studies reported significant differences . The two other studies that did not perform statistical analyses concluded that corticosteroids improved renal function . These studies had small sample sizes and true differences between groups were not assessed with statistical measures.…”

“…Four of the eight studies ascribed no ADR to corticosteroids, without further details provided . One study reported that 4.7% of patients developed diabetes; however, it was unclear if this ADR applied only to patients with DI‐AIN or AIN from other causes …”

“…The need for RRT was reported in six studies; however, the time point reported for initiation varied across studies, including two studies where the time point was unclear. Two studies reported the need for RRT around the time of biopsy .…”

“…The need for RRT was reported in six studies; however, the time point reported for initiation varied across studies, including two studies where the time point was unclear. Two studies reported the need for RRT around the time of biopsy . Of these, one study reported differences across treatment groups (14% in the corticosteroid treated group vs 0% in the non‐corticosteroid group), while the other did not (58% of total patients around the time of biopsy) .…”

“…Two studies reported the need for RRT around the time of biopsy . Of these, one study reported differences across treatment groups (14% in the corticosteroid treated group vs 0% in the non‐corticosteroid group), while the other did not (58% of total patients around the time of biopsy) . Two studies reported the need for long‐term RRT .…”