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Early steroid treatment improves the recovery of renal function in patients with drug-induced acute interstitial nephritis
Open accessAbstract
The role of steroid treatment in drug-induced acute interstitial nephritis (DI-AIN) is controversial. We performed a multicenter retrospective study to determine the influence of steroids in 61 patients with biopsy-proven DI-AIN, 52 of whom were treated with steroids. The responsible drugs were antibiotics (56%), non-steroidal anti-inflammatory drugs (37%) or other drugs. The final serum creatinine was significantly lower in treated patients while almost half of untreated patients remained on chronic dialysis. Among treated patients, over half showed a complete recovery of baseline renal function, whereas the rest remained in renal failure. There were no significant initial differences between these two subgroups in terms of duration or dosage of steroids. After withdrawal of the presumed causative drug, we found that when steroid treatment was delayed (by an average of 34 days) renal function did not return to baseline levels compared to those who received steroid treatment within the first 2 weeks after withdrawal of the offending agent. We found a significant correlation between the delay in steroid treatment and the final serum creatinine. Renal biopsies, including three patients who underwent a second biopsy, showed a progression of interstitial fibrosis related to the delay in steroid treatment. Our study shows that steroids should be started promptly after diagnosis of DI-AIN to avoid subsequent interstitial fibrosis and an incomplete recovery of renal function.
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“during the case of an antibiotic-related AIN, clinicians may require the use of alternative antibiotic drugs along with the application of an immunosuppressant [3, 6, 16, 17]”
From The diagnosis of acute interstitial nephritis caused by infection versus antibiotic-induced interstitial nephritis: a narrative review (2024) · cites this paper as [17]
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BackgroundAcute Kidney Injury in Patients with Inactive Cytochrome P450 Polymorphisms
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“suggest that early corticosteroid treatment may improve the recovery of renal function and slow the progression to interstitial fibrosis.([23]) In conclusion, we report two cases where CYP deficiencies could have played an important role in acute kidney injury.”
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“In addition to prompt withdrawal of the offending agent, early initiation of corticosteroids has shown to be beneficial in improving renal outcomes, especially in severe cases [3, 4].”
BackgroundRare allergic reaction of the kidney: sitagliptin-induced acute tubulointerstitial nephritis
Alsaad, A. A., Dhannoon, S., Pantin, S. A., & Porter, I. (2016) · BMJ Case Reports · doi:10.1136/bcr-2016-216297 · Cited by 6
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“fibrosis and scarring, and promoting faster recovery of renal function without long term complications (3-5,8,11).”
BackgroundInfluentialAcute renal failure associated with albendazole therapy in a patient with trichinosis
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“The most recent multicenter retrospective study published by González et al 7 in 2008 showed signi fi cant bene fi ts of corticosteroids in AIN.”
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“Oral Steroid dosing is recommended to be weight based at 1mg/kg, we used a low dose of oral prednisolone and discontinued the letrozole [8].”
MethodResultNew challenges in tubulointerstitial nephritis induced by drugs.
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[When to use steroid treatment for those patients with drug-induced acute interstitial nephritis?].
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“In a multicenter retrospective study involving 61 cases of biopsy-proven DI-AIN, a delay in steroid initiation (34 days versus 13 days) was associated with poor renal recovery [17].”
Short-term steroid therapy for immune-checkpoint-inhibitor-related acute kidney injury
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“This treatment can reduce the duration of immune suppression and the possible development of adverse events associated with steroid therapy [7].”
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Hematuria Is Associated with More Severe Acute Tubulointerstitial Nephritis
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“55 mg/dL [5,15], and proteinuria was below the nephrotic range [5,7].”
BackgroundCocaine-Induced Acute Interstitial Nephritis: A Comparative Review of 7 Cases
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Metadata
- Authors
- González, E., Gutiérrez, E., Galeano, C., Chevia, C., de Sequera, P., Bernis, C., Parra, E. G., Delgado, R., Sanz, M., Ortiz, M., Goicoechea, M., Quereda, C., Olea, T., Bouarich, H., Hernández, Y., Segovia, B., & Praga, M.
- Affiliations
- Hospital Universitario 12 De Octubre (ES)
- Hospital Universitario Ramón y Cajal (ES)
- Hospital Universitario La Paz (ES)
- Hospital Universitario de La Princesa (ES)
- Hospital Ruber Internacional (ES)
- Hospital Universitario de Getafe (ES)
- Hospital Universitario Severo Ochoa (ES)
- Hospital General Universitario Gregorio Marañón (ES)
- Corresponding author
- Praga, M.
- Venue
- Kidney International
- Publisher
- Elsevier BV
- Published
- 2008-04
- Volume
- 73
- Issue
- 8
- Pages
- 940-946
- ISSN
- 0085-2538 (ISSN-L)
- OpenAlex
- W2128802116
- Cited by
- 466
- References
- 0
- Citations by year
- 2026: 19 · 2025: 26 · 2024: 32 · 2023: 23 · 2022: 32 · 2021: 34 · 2020: 30 · 2019: 38 · 2018: 27 · 2017: 28 · 2016: 23 · 2015: 28 · 2014: 23 · 2013: 18 · 2012: 23
- FWCI
- 16.36
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Kidney International (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
- Health Sciences › Medicine › Nephrology › Nephrotoxicity and Medicinal Plants
- Health Sciences › Medicine › Nephrology › Renal Diseases and Glomerulopathies
- Keywords
- drug-induced acute interstitial nephritis, corticosteroid therapy, renal function recovery, interstitial fibrosis, nonsteroidal anti-inflammatory drugs, serum creatinine, dialysis dependence, renal biopsy
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Anti-Inflammatory Agents, Non-Steroidal, Biopsy, Creatinine, Drug Administration Schedule, Female, Humans, Kidney, Male, Middle Aged, Nephritis, Interstitial, Retrospective Studies, Steroids
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