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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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InfluentialKim, D. W., Jeong, I. H., Son, Y., Rha, S.-H., & Chung, Y.-S. (2024) · Transplantation Proceedings · doi:10.1016/j.transproceed.2024.10.042 · Cited by 2
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“Corticoste-roids use is controversial, but the benefit of corticosteroid use in drug-induced AIN has been reported [6,7].”
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“Similar to other causes of ATIN [12] including immune”
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“Dis - continuation of offending drug and early use of glucocorticoid therapy remains the main - stay of treatment [11, 12].”
BackgroundFiller-Induced Interstitial Nephritis in a Male-to-Female Transgender Person: A Case Report
Al-Thnaibat, M., Mohd, A. B., Mohd, O., Ghannam, R. A., Issa, M., & Sawaqed, S. (2022) · Cureus · doi:10.7759/cureus.31407 · Cited by 1
“As a result, the study strongly suggests that steroid treatment is indicated in drug-induced interstitial nephritis and should be initiated as soon as possible after diagnosis to avoid the risk of incomplete renal function recovery [9].”
BackgroundInfluentialNephrological management of renal cell carcinoma (RCC) patients: A narrative review
Pirovano, M., & Cosmai, L. (2022) · Journal of Onco-Nephrology · doi:10.1177/23993693221098444 · Cited by 1
Acute interstitial nephritis observed with three different triggering agents
Nobakht, N., Hanna, R. M., Kamgar, M., Sinclair, J., Simon, L., Emami, S., Sisk, A., & Rastogi, A. (2022) · Clinical Case Reports · doi:10.1002/ccr3.5432 · Cited by 1
Li, N. L., Flores, K., Prosek, J., Brodsky, S., & Ayoub, I. (2021) · Kidney International Reports · doi:10.1016/j.ekir.2021.11.025 · Cited by 1
“Therefore, steroid therapy was initiated given the renal biopsy demonstrated significant activity without chronicity, and the evidence that early therapy is associated with improved outcomes in AIN.(8) Our patient received premedication with 4 mg BID dexamethasone with each infusion of camidanlumab tesirine.”
BackgroundAcute tubulointerstitial nephritis induced by the tyrosine kinase inhibitor vandetanib
Teran, M. P., Ribas, A. M., Alemany, N. M., Freiria, X. B., Rubió-Casadevall, J., Bueno, F. P., Méndez, I. G., Devia, M. C., Paez, C. N., Escuder, P. T., et al. (2020) · Investigational new drugs · doi:10.1007/s10637-020-00973-8 · Cited by 1
Nefritis tubulointersticial aguda. Revisión bibliográfica
Nieto-Ríos, J. F., Ruiz-Velásquez, L. M., Álvarez, L., & Serna-Higuita, L. (2020) · IATREIA · doi:10.17533/udea.iatreia.45 · Cited by 1
“(46) 26 16 1,63(1,2-2,4) 1,60 (1,3-2,1) No dato No dato González et al. 2008 (47) 52 9 2,1(0,7-12,7) 3,7 (0,7-8,9) 2 (3,8”
Nefritis intersticial aguda a causa de rifampicina
García, E. H., & Sánchez, M. J. T. (2019) · Medicina Clínica Práctica · doi:10.1016/j.mcpsp.2019.01.006 · Cited by 1
Khan, H., Rahim, M., Ananna, M., Chowdhury, T., & Iqbal, S. (2018) · BIRDEM Medical Journal · doi:10.3329/birdem.v8i3.38134 · Cited by 1
Tubulointerstitial Nephritis Associated with Enteritis and Sacroiliitis
Ushimaru, S., Ichikawa, D., Yazawa, M., Suzuki, T., Okada, E., Koike, J., & Shibagaki, Y. (2018) · Internal medicine · doi:10.2169/internalmedicine.1255-18 · Cited by 1
“It is important to identify cases of tubulointerstitial nephritis with the potential for renal recovery as some patients with tubulointerstitial nephritis show at least partial improvement with early medical treatment (1, 2).”
BackgroundDie tubulointerstitielle Nephritis (medikamentös/infektiös)
Strutz, F., & Grupp, C. (2018) · Deutsche Medizinische Wochenschrift · doi:10.1055/a-0511-8458 · Cited by 1
“Immerhin konnte in einer retrospektiven Untersuchung bei 61 Patienten mit histologisch gesicherter TIN der Nutzen gezeigt werden [16].”
BackgroundПочечная безопасность ингибиторов протонной помпы
Дядык, А. И., & Kügler, T. (2017) · The Russian Archives of Internal Medicine · doi:10.20514/2226-6704-2017-7-6-415-422 · Cited by 1
“Gonzalez в ретроспективном многоцентровом исследовании, оценив 61 больного с ОТИН [56].”
Néphropathies médicamenteuses immunoallergiques
Renaudineau, E., Morice, S., Picard, S., Rioux-Leclerc, N., & Laigneau, M. (2017) · EMC - Néphrologie · doi:10.1016/s1762-0945(17)64384-5 · Cited by 1
Acute Tubulointerstitial Nephritis due to Phenytoin: Case Report
Bresolin, N., Docusse, P., Shiozawa, M., Moreira, M. R. D. B., & Silveira, N. (2017) · Journal of Clinical Nephrology · doi:10.29328/journal.jcn.1001004 · Cited by 1
“The use of corticoids remains shrouded in controversy, but has been widely used in cases with important deterioration of kidney function, and has shown favourable results [4,17].”
BackgroundInfluentialAcute interstitial nephritis in the south of Iran; an observational study
Khodamoradi, Z., Pakfetrat, M., Torabinezhad, S., & Sagheb, M. (2017) · Journal of Nephropathology · doi:10.15171/jnp.2017.37 · Cited by 1
“Goicoechea et al showed that 85% of their patients had AKI, but there is not any data about dialysis requirement in their series but in the pooled data from González et al, and Clarkson et al, 40% of patients needed dialysis treatment while all of them had AKI (1,24).”
BackgroundReversible Fluindione-Induced Chronic Interstitial Nephritis
Crépin, T., Bamoulid, J., Courivaud, C., Dahmani, O., Félix, S., & Ducloux, D. (2016) · Case Reports in Nephrology · doi:10.1155/2016/9818195 · Cited by 1
“Nevertheless, benefit seems greaterwhen steroids are begun soon after diagnosis (<15 days) and in the absence of significant fibrosis and tubular atrophy on renal histology [1, 3, 11].”
BackgroundFurosemide Overuse-related Acute and Chronic Tubulointerstitial Nephritis: A Case Report
Yu, T.-C., & Hsu, Y.-H. (2015) · 內科學誌 · doi:10.6314/jimt.2015.26(4).05 · Cited by 1
Treatment of Renal Disease: From Where Does the Opposite View Come?
El-Sherif, A. (2010) · Nephron Clinical Practice · doi:10.1159/000319592 · Cited by 1
The renal failure that vanished.
Lee, E., Kurtz, P., Chang, A., & Swamy, R. (2010) · Journal of Hospital Medicine · doi:10.1002/jhm.406 · Cited by 1
Furosemide, orlistat and non-steroidal anti-inflammatory agents—too much for the kidneys to handle!
Korzets, A., Gafter, U., Tobar, A., Chagnac, A., Zingerman, B., & Ori, Y. (2009) · NDT plus · doi:10.1093/ndtplus/sfn217 · Cited by 1
Fluindione-induced immuno-allergic interstitial nephritis
Kheder-Elfekih, R., Poitou, C., Brocheriou, I., Depreneuf, H., & Izzedine, H. (2008) · NDT plus · doi:10.1093/ndtplus/sfn171 · Cited by 1
Yonekawa, K. E., Barreto, E. F., & Sutherland, S. M. (2021) · Springer eBooks · doi:10.1007/978-3-642-27843-3_126-1
New challenges in tubulointerstitial nephritis induced by drugs
Juarez, G. F., Pérez, J. V., Fontán, F. C., Corona, C., Alamo, B. S., & Ribera, A. T. (2019) · Nefrología (English Edition) · doi:10.1016/j.nefroe.2019.08.006 · Cited by 1
Yamazaki, T., Sasaki, Y., & Miyakawa, H. (2017) · Nihon Toseki Igakkai Zasshi · doi:10.4009/jsdt.50.301 · Cited by 1
Mohamed, S. H., El-Kady, D., Elmegeed, G. A., El-kassaby, M. I., Farrag, A., Abdelhalim, M., & Ali, N. A. (2022) · Journal of Applied Pharmaceutical Sciences · doi:10.7324/japs.2023.89473
Delayed Drug Hypersensitivity: Mechanistic Advances and Emerging Therapies
Siddiqui, A., Chow, T. G., Runyon, L. M., Phillips, E. J., & Arango, S. A. (2026) · Current Allergy and Asthma Reports · doi:10.1007/s11882-026-01300-6
“…non-steroidal anti-inflammatory drugs, antibiotics, and checkpoint inhibitors account for most cases, and delayed recognition allows interstitial fibrosis to develop, so that a proportion of patients never regain baseline function despite withdrawal and corticosteroid treatment [ 88 , 89].”
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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