Aetiology, course and treatment of acute tubulointerstitial nephritis in paediatric patients: a cross-sectional web-based survey

Abstract

BackgroundAcute tubulointerstitial nephritis (TIN) is a significant cause of acute renal failure in paediatric and adult patients. There are no large paediatric series focusing on the aetiology, treatment and courses of acute TIN.Patients, design and settingWe collected retrospective clinical data from paediatric patients with acute biopsy-proven TIN by means of an online survey. Members of four professional societies were invited to participate.ResultsThirty-nine physicians from 18 countries responded. 171 patients with acute TIN were included (54% female, median age 12 years). The most frequent causes were tubulointerstitial nephritis and uveitis syndrome in 31% and drug-induced TIN in 30% (the majority of these caused by non-steroidal anti-inflammatory drugs). In 28% of patients, no initiating noxae were identified (idiopathic TIN). Median estimated glomerular filtration rate (eGFR) rose significantly from 31 at time of renal biopsy to 86 mL/min/1.73 m2 3–6 months later (p<0.001). After 3–6 months, eGFR normalised in 41% of patients (eGFR ≥90 mL/min/1.73 m2), with only 3% having severe or end-stage impairment of renal function (<30 mL/min/1.73 m2). 80% of patients received corticosteroid therapy. Median eGFR after 3–6 months did not differ between steroid-treated and steroid-untreated patients. Other immunosuppressants were used in 18% (n=31) of patients, 21 of whom received mycophenolate mofetil.ConclusionsDespite different aetiologies, acute paediatric TIN had a favourable outcome overall with 88% of patients showing no or mild impairment of eGFR after 3–6 months. Prospective randomised controlled trials are needed to evaluate the efficacy of glucocorticoid treatment in paediatric patients with acute TIN.

Nephropathy in a Child with Severe Recessive Dystrophic Epidermolysis Bullosa Treated with Cyclophosphamide: A Case Report

“…A repeated-biopsy study found that steroid treatment reversed active lesions and prevented chronic lesion progression [21]. Consequently, early steroid therapy in children may reasonably treat acute lesions before chronic ones develop [10, 22]. We initially treated our case with adequate doses of prednisone and lisinopril.…”

Pediatric uveitis: Role of the pediatrician

“…Main clinical and laboratory features of TINU include sudden onset of bilateral non-granulomatous anterior uveitis (rare posterior uveitis or panuveitis) associated with typical anterior uveitis symptoms (eye pain, redness, decreased vision, and photophobia) and mildly to moderately abnormal renal function, in particular elevated Creatinine with or without raised urea, high inflammatory markers (ESR, CRP), abnormal urinalysis (low-grade proteinuria, normoglycemic glucosuria, microscopic haematuria and elevated β2-microglobulin). To confirm the renal involvement, kidney biopsy can be considered demonstrating tubulointerstitial inflammatory infiltrations containing lymphocytes and non-specific histiocytes with vessels and glomeruli being typically spared ( 87 , 90 , 92 ). Apart from the mentioned above clinical and laboratory changes, most of the patients with TINU have systemic features, including fever, weight loss, fatigue, and abdominal/flank pain.…”

“…TINU is a rare benign autoimmune condition of unknown etiology characterized by combined ocular and renal damage. Usually, the eye inflammation precedes or is diagnosed soon after the accidental finding of renal abnormalities and associated systemic features (87)(88)(89).…”

Tubulointerstitial nephritis and uveitis in children during the COVID-19 pandemic: report of four cases

“…It is usually detected in teenagers with a median age of 13 years with a female preponderance [ 2 , 4 ]. Presenting features are often non-specific with initial reports of fatigue, nausea, vomiting, weight loss, myalgia, fever and often delayed onset eye symptoms of pain, erythema, photophobia and reduced visual acuity [ 5 ]. Alongside impairment of kidney function, patients can develop normo- or hypokalaemia with anaemia, eosinophilia and high erythrocyte sedimentation rate (ESR).…”