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

Quinto, Lena; Sukkar, Louisa; Gallagher, Martin

doi:10.1111/imj.14081

Cited by 10 publications

(8 citation statements)

References 23 publications

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“…The use of corticosteroids in the treatment of DI-AIN is controversial and has not demonstrated consistent benefit. 5 , 20 Some studies have shown improvement of kidney function recovery with early initiation of corticosteroid therapy. 17 , 20 DI-AIN is a T-cell-mediated hypersensitivity reaction, and the suppressor effect of steroids on T cells and eosinophils may control inflammation.…”

Section: Discussionmentioning

confidence: 99%

“…5 , 20 Some studies have shown improvement of kidney function recovery with early initiation of corticosteroid therapy. 17 , 20 DI-AIN is a T-cell-mediated hypersensitivity reaction, and the suppressor effect of steroids on T cells and eosinophils may control inflammation. 3 The lack of high-quality randomized controlled trials regarding the use of corticosteroids in the treatment of DI-AIN suggests that more research should be performed.…”

Section: Discussionmentioning

confidence: 99%

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Severe acute interstitial nephritis secondary to minocycline use in an adolescent girl

Sharma

Geagan

Tengsupakul

2020

SAGE Open Medical Case Reports

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Acute interstitial nephritis is an uncommon but classic complication of minocycline therapy for acne. A 14-year-old African American girl was started on oral minocycline for the treatment of acne 6 weeks before presentation. After 4 weeks on minocycline, she developed a generalized rash, anasarca, fever, myalgia, nausea, vomiting, sore throat, and generalized body weakness. The evaluation showed increased levels of serum creatinine, urea nitrogen, and serum alanine and aspartate aminotransferases. Renal ultrasonography showed bilateral enlarged, echogenic kidneys, and percutaneous renal biopsy showed features of acute allergic interstitial nephritis. Treatment included methylprednisolone and intravenous fluids and discontinuation of minocycline. The elevated serum creatinine level (12.9 mg/dL (reference, 0.40–0.70 mg/dL)) suggests marked renal impairment corresponding with Kidney Disease Improving Global Outcomes acute kidney injury classification stage 3. The kidney injury improved from stage 3 to stage 1 within 3 days, and early treatment with steroids might have prevented chronic renal failure. The creatinine level promptly decreased to normal, and liver enzyme results also improved. In summary, the diagnosis of acute interstitial nephritis should be considered in patients who present with renal failure associated with recent use of minocycline, and treatment with corticosteroids should be considered early during the hospitalization.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Severe acute interstitial nephritis secondary to minocycline use in an adolescent girl

Sharma

Geagan

Tengsupakul

2020

SAGE Open Medical Case Reports

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“…[24–27] In a recent research, Quinto LR et al made a systemic review of 8 retrospective studies comparing the effects of corticosteroid therapy versus non-corticosteroid therapy in the treatment of drug induced AIN. [28] Four studies showed no difference in serum creatinine between corticosteroid and non-corticosteroid therapy, while 4 studies found a benefit of corticosteroid therapy. Regretfully, a meta-analysis was not performed due to considerable heterogeneity.…”

Section: Discussionmentioning

confidence: 99%

Severe acute interstitial nephritis induced by valsartan

Chen

et al. 2019

Medicine

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Rationale: Angiotensin receptor blocker (ARB) can increase serum creatinine or potassium levels in patients with renal insufficiency, renal artery stenosis, heart failure or hypovolemia, but hardly cause severe kidney injury in patients without any risk factors. A case of severe acute interstitial nephritis (AIN) induced by valsartan was reported here. Patient concerns: A 62-year-old female with nausea for 1 month and acute deterioration of kidney function for 2 weeks was admitted. She had a history of hypertension for 5 months and had taken valsartan 40 mg daily for 4 months. Although the valsartan had been stopped for 2 weeks, the serum creatinine continuously increased after admission. Kidney biopsy demonstrated the eosinophils infiltration in interstitium. Diagnoses: AIN induced by valsartan. Interventions: The patient was treated with glucocorticoid. Outcomes: The serum creatinine decreased gradually and got back to normal level 5 months later. Then therapy of glucocorticoid was stopped. Renal artery stenosis was excluded by computed tomography angiography (CTA). Lessons: Although valsartan-induced allergy has been reported previously, AIN was firstly recognized as a severe complication of this drug. We suggest when there is a ARB-associated continuous deterioration of kidney function for patients without renal insufficiency, renal artery stenosis, heart failure or hypovolemia, AIN should be thought of and therapy with glucocorticoid should be considered if necessary.

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“…1 We weren't able to metaanalyse these studies because of their considerable heterogeneity and low quality of evidence, but it is noteworthy that they included a total of just 430 patients, 300 treated with corticosteroids and 130 with other, poorly-defined treatments (Table 1). 1 The literature since the systematic review is notable for one randomized trial (which compared oral with intravenous corticosteroid therapy), two retrospective analyses which added a further 295 patients to the literature, with 274 patients receiving corticosteroids. [2][3][4] The epidemiological features lacking in the literature; prospective patient recruitment, control groups and randomization, are critical in the setting of DI-AIN.…”

Section: The Evidencementioning

confidence: 99%

Should Corticosteroids Be Used to Treat Biopsy-Proven Drug-Induced Acute Interstitial Nephritis?: CON

Gallagher

Kotwal

2022

Kidney360

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

Abstract: The limited evidence does not support the use of corticosteroids in the treatment of DI-AIN. Larger, well-designed trials are needed to help guide clinical management of this condition. This article is protected by copyright. All rights reserved.

Cited by 10 publications

References 23 publications

Severe acute interstitial nephritis secondary to minocycline use in an adolescent girl

Severe acute interstitial nephritis secondary to minocycline use in an adolescent girl

Severe acute interstitial nephritis induced by valsartan

Should Corticosteroids Be Used to Treat Biopsy-Proven Drug-Induced Acute Interstitial Nephritis?: CON

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