Acute interstitial nephritis â a reappraisal and update

Raghavan, Rajeev; Eknoyan, Garabed

doi:10.5414/cn10838

Cited by 140 publications

(140 citation statements)

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“…The recognition of AIN is important, as early discontinuation of the offending medication improves prognosis 1 2. The reported incidence of AIN ranges from 1% to 10% of the total biopsies examined, with an overall average of 2.8% 1. The incidence of AIN increases among biopsies done specifically to evaluate acute renal failure of unknown origin, where it ranges from 6.5% to 35%, with an overall average of 13.5% 1.…”

Section: Discussionmentioning

confidence: 99%

“…The reported incidence of AIN ranges from 1% to 10% of the total biopsies examined, with an overall average of 2.8% 1. The incidence of AIN increases among biopsies done specifically to evaluate acute renal failure of unknown origin, where it ranges from 6.5% to 35%, with an overall average of 13.5% 1. As such, most estimates of the prevalence of AIN are based on retrospective reviews of biopsy registries, and the actual incidence of AIN goes grossly underestimated, in part, due to reluctance of the physicians, low index of suspicion and if the biochemical changes improve after discontinuation of the medication 3…”

Section: Discussionmentioning

confidence: 99%

“…A recent literature search showed that there were greater than 50 reported cases associated with omeprazole 1. However, she was taking the medication for close to 36 months prior to the presentation.…”

Section: Differential Diagnosismentioning

confidence: 99%

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Cyclooxygenase-2 inhibitor-induced acute interstitial nephritis

et al. 2017

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A 64-year-old female patient presented to the emergency department with a 3-week history of persistent nausea and vomiting. Her serum creatine prior to admission was 118 µmol/L and on presentation was elevated to 420 µmol/L. On clinical history, she indicated that 3 weeks prior, she had been initiated on a cyclooygenase-2 (COX-2) inhibitor, celecoxib, for her osteoarthritis of her knees. Renal biopsy confirmed the diagnosis of acute interstitial nephritis (AIN). Celecoxib was discontinued and the patient's renal function improved to a discharge creatine of 205-220 µmol/L. Nine months later, her creatine had decreased to 195 µmol/L and she was initiated on tapering doses of prednisone therapy for 4 months, after which time her creatine had improved further to 143 µmol/L. She was later transitioned to mycophenolatemofetil for 9 months and her creatine improved to 110 µmol/L. This report provides further evidence that COX-2 inhibitors are associated with AIN.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Cyclooxygenase-2 inhibitor-induced acute interstitial nephritis

et al. 2017

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“…It was considered the first studied type of AIN. This case of AIN result from an immune reaction against renal interstitial endogenous antigens through cell-mediated immune mechanisms and also hapten-mediated mechanism in some infections (2,3). …”

Section: Introductionmentioning

confidence: 99%

“…Its incidence has decreased due to widespread use of antibiotics, and accounts for 5%-10% of all AIN cases, but with recent advancement of early diagnostic techniques it is becoming more common (1-3). Its true incidence is often underestimated as suspected patients with clinical evidence are not always subjected to renal biopsy for confirmation.…”

Section: Introductionmentioning

confidence: 99%

Infection associated acute interstitial nephritis; a case report

Raina¹,

Ale²,

Chaturvedi³

et al. 2016

J Nephropathol

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BackgroundAcute interstitial nephritis (AIN) is a clinico-pathological syndrome associated with a variety of infections, drugs, and sometimes with unknown causes. It is a common cause of acute kidney injury (AKI) and subsequent renal impairment, which often times is under-diagnosed. Infection-associated AIN occurs as a consequence of many systemic bacterial, viral, and parasitic infec-tions; however, its incidence has decreased significantly after the advent of antimicrobials. Infection-associated AIN presents with both oliguric or non-oliguric renal insufficiency, without the classical clinical triad of AIN (fever, rash, and arthralgia). In this scenario the renal function is usually reversible after the infection is treated. In most cases, patients with acute renal failure present with extra-renal manifestations typically detected in underlying infections. Renal biopsy serves as the most definitive test for both the diagnosis and prognosis of AIN.Case PresentationIn this paper, we will address one such case of biopsy-proven AIN. In this case, the patient presented with severe AKI induced by anaerobic streptococcus, leading to a periodontal abscess, which was successfully treated with corticosteroids and requiring renal replacement therapy (RRT).ConclusionsAIN should be considered in the differential for unexplained AKI. Initial management should include conservative therapy by withdrawing any suspected causative agent. Renal biopsy is needed for confirmation in cases where kidney function fails to improve within 5–7 days on conservative therapy. Risk of immunosuppression is very important to consider when giving steroids in patients with infection induced AIN, and steroids may have to be delayed until the active infection is completely controlled.

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