Acute tubulointerstitial nephritis, treatment with steroid and impact on renal outcomes

Raza, Muhammad; Hadid, Muhammad; Keen, C. E.; Bingham, Coralie; Salmon, Andrew

doi:10.1111/j.1440-1797.2012.01648.x

Cited by 32 publications

(23 citation statements)

References 14 publications

(31 reference statements)

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“…In a study of 187 patients with AIN (25% with drug-induced AIN, 48% with "unknown" cause), corticosteroid-treated patients had better kidney function at 2 years and lower dialysis dependence compared with those who did not receive these drugs (3). Similar outcomes were observed in other studies (4)(5)(6). Early identification of drug-induced AIN and treatment with corticosteroids were associated with better kidney function and lower need for dialysis in some studies (4,6).…”

supporting

confidence: 64%

Treatment of Drug-Induced Acute Tubulointerstitial Nephritis

Moledina

Perazella

2018

CJASN

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supporting

confidence: 64%

Treatment of Drug-Induced Acute Tubulointerstitial Nephritis

Moledina

Perazella

2018

CJASN

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“…Most patients with ATIN in these studies were treated with steroids (59 – 87%), and different criteria were applied to evaluate renal recovery in each article. Three of these studies [12, 13, 16] showed that steroids were effective in renal outcome, while the other three [11, 14, 15] did not. Among the studies that analyzed the effect of steroids on drug-induced ATIN, only one study [12] showed a positive result of steroid use.…”

Section: Discussionmentioning

confidence: 99%

Effect of steroids and relevant cytokine analysis in acute tubulointerstitial nephritis

Yun

Jang

et al. 2019

BMC Nephrol

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BackgroundAcute tubulointerstitial nephritis (ATIN) is an important cause of acute kidney injury and often a potentially reversible disease. However, the role of steroids in ATIN remains controversial and the underlying mechanisms remain unresolved.MethodsA total of 113 adult patients with biopsy-proven ATIN were recruited from three tertiary referral centers. Of 102 patients with idiopathic or drug-induced ATIN, outcomes such as renal recovery, end-stage renal disease, and all-cause mortality were compared between the steroid-treated and non-treated groups. Plasma and urine inflammatory cytokine levels at the time of biopsy were analyzed in patients (n = 33) using a bead-based multiplex assay and compared with those of healthy individuals (n = 40).ResultsSteroids were used in 92 (81.4%) of the total patients and in 82 (80.3%) patients with idiopathic or drug-induced ATIN. The rate of renal recovery and the risks of end-stage renal disease and mortality were not different between the steroid-treated and non-treated groups. Despite using a propensity score matching method (n = 20 in each group), none of the outcomes were different between the two groups. Several cytokines, such as monocyte chemotactic protein-1, interferon-α, and interleukin-6 and interleukin-8 levels, were markedly elevated in plasma and urine of patients compared with those in healthy individuals. However, cytokines related to Th2 response, such as IL-10, IL-33, were not different between the two groups.ConclusionsSteroid use does not affect the overall outcome of ATIN. Based on the fact that targeting therapy should be investigated to improve outcomes, the present cytokine results will be helpful for developing a novel therapy for ATIN.Electronic supplementary materialThe online version of this article (10.1186/s12882-019-1277-2) contains supplementary material, which is available to authorized users.

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“…The authors also demonstrated that time to starting steroid treatment was important; those who completely recovered renal function started steroids at an earlier time point than those who had incomplete recovery. A more recent series by Raza et al [28] reports 49 patients with AIN, 37 of whom were treated with steroids. They report a greater improvement in eGFR in patients treated with steroids; mean improvement in eGFR was 3.4-fold in the steroid-treated group compared with 2.0-fold in the untreated group.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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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.

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Acute tubulointerstitial nephritis, treatment with steroid and impact on renal outcomes

Abstract: StG patients had a greater degree of improvement in renal function, but with no correlation between degree of improvement in eGFR and delay in starting steroids, and similar eGFR values at final follow-up. PPI were the second commonest drug category among drug-induced cases.

Cited by 32 publications

References 14 publications

Treatment of Drug-Induced Acute Tubulointerstitial Nephritis

Treatment of Drug-Induced Acute Tubulointerstitial Nephritis

Effect of steroids and relevant cytokine analysis in acute tubulointerstitial nephritis

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

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