Diagnosing acute interstitial nephritis: considerations for clinicians
Open accessAbstract
Acute interstitial nephritis (AIN) is a common cause of acute kidney injury (AKI), particularly in hospitalized patients. It can be difficult for clinicians to differentiate between AIN and other common causes of AKI, most notably acute tubular necrosis (ATN) and prerenal injury. Clinicians often struggle with the clinical history and laboratory data available to definitively diagnose AIN. Sometimes they diagnose ATN or AIN based on these flawed data. Thus it is important that clinicians be familiar with the utility of commonly ordered tests used to aid in the diagnosis. Unfortunately, no single test performs particularly well on its own, and until a biomarker is rigorously shown to be diagnostic of AIN, most patients require a kidney biopsy to definitively establish the diagnosis and direct further management.
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White blood cell casts are demonstrated in intrarenal infection such as pyelonephritis or in inflammatory renal lesions such as proliferative glomerulonephritis and AIN, rendering them non-specific and insensitive for AIN.
“The presence of white blood cell (WBC) casts has been demonstrated in the context of intrarenal infection, such as pyelonephritis, or in conjunction with inflammatory renal lesions, such as proliferative glomerulonephritis and AIN, rendering them non-specific and insensitive for AIN [49].”
From The diagnosis of acute interstitial nephritis caused by infection versus antibiotic-induced interstitial nephritis: a narrative review (2024) · cites this paper as [49]
Mild to moderate proteinuria in AIN is incapable of distinguishing between infection or antibiotic as the causative agent, or among other AIN etiologies.
“Numerous studies on AIN have reported the presence of mild to moderate proteinuria, which is incapable of distinguishing between infection or antibiotic as the causative agent, or among other AIN etiologies [49].”
From The diagnosis of acute interstitial nephritis caused by infection versus antibiotic-induced interstitial nephritis: a narrative review (2024) · cites this paper as [49]
Cites
González, E., Gutiérrez, E., Galeano, C., Chevia, C., de Sequera, P., Bernis, C., Parra, E. G., Delgado, R., Sanz, M., Ortiz, M., et al. (2008) · Kidney International · doi:10.1038/sj.ki.5002776 · Cited by 466 · cited 2× · see citing works
“Two subsequent studies found that eosinophilia was present in 36% [17] and 34% [18] of biopsy-proven cases of AIN.”
BackgroundAcute interstitial nephritis: clinical features and response to corticosteroid therapy
Clarkson, M. R. (2004) · Nephrology Dialysis Transplantation · doi:10.1093/ndt/gfh485 · Cited by 343 · see citing works
Clinical Approach to Diagnosing Acute and Chronic Tubulointerstitial Disease
Perazella, M. A. (2017) · Advances in Chronic Kidney Disease · doi:10.1053/j.ackd.2016.08.003 · Cited by 79 · see citing works
Self-citationUrinary Sediment Findings in Acute Interstitial Nephritis
Fogazzi, G. B., Ferrari, B., Garigali, G., Simonini, P., & Consonni, D. (2012) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2012.05.002 · Cited by 71 · see citing works
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Muhammad, A., Zhang, Y., Huang, L., Yuan, Q., Wang, W., Pu, J., Lin, W., Tang, R., & Xiao, X. (2024) · Clinical Kidney Journal · doi:10.1093/ckj/sfae054 · Cited by 13 · see citing works
“Drugs, particularly antibiotics, are known to cause AIN, which is a drug hypersensitivity reaction ( DHR) that manifests itself within 7–10 days of exposure to the offending drug [20 ] ( Tables 1 and 2 [32 –49 ]) .”
BackgroundInfluentialClozapine-Induced Acute Interstitial Nephritis
Ragg, J., Innes, S., Bannon, F., & Hope, J. (2026) · Journal of clinical psychopharmacology · doi:10.1097/jcp.0000000000002192 · Cited by 2 · see citing works
- Authors
- Nussbaum, E. Z., & Perazella, M. A.
- Affiliations
- Yale New Haven Hospital (US)
- United States Department of Veterans Affairs (US)
- Corresponding author
- Perazella, Mark A
- ORCID
- Perazella, Mark A
- Venue
- Clinical Kidney Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2019-07-11
- ISSN
- 2048-8505 (ISSN-L)
- 2048-8513
- OpenAlex
- W2960711315
- Cited by
- 29
- References
- 4
- Citations by year
- 2025: 3 · 2024: 4 · 2023: 4 · 2022: 6 · 2021: 6 · 2020: 5 · 2019: 1
- FWCI
- 3.50
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Clinical Kidney Journal (publishedVersion, cc-by-nc)
- Topics
- Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Nephrotoxicity and Medicinal Plants
- Health Sciences › Medicine › Nephrology › Renal Diseases and Glomerulopathies
- Keywords
- acute interstitial nephritis, acute kidney injury, acute tubular necrosis, differential diagnosis, diagnostic biomarkers, renal biopsy, laboratory testing, hospitalized patients
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