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Duration of Treatment with Corticosteroids and Recovery of Kidney Function in Acute Interstitial Nephritis
Open accessAbstract
Background and objectives: Drug-induced acute interstitial nephritis represents an emerging cause of acute kidney disease, especially among polymedicated elderly patients. Although corticosteroids are frequently used, controversy exists about the timing of initiation, efficacy, safety, and duration of treatment. Design, setting, participants, & measurements: We performed a retrospective study of 182 patients with biopsy-proven drug-induced acute interstitial nephritis from 13 Spanish centers. Exposure was defined as the length of corticosteroid treatment. The main outcome was the level of serum creatinine at month 6, with respect to baseline values. Results: The most common offending agents were nonsteroidal anti-inflammatory drugs (27%). In 30% of patients, the offending drug could not be identified. The median time to suspected drug withdrawal was 11 days (interquartile range, 5–22). All patients presented with acute kidney disease and were treated with corticosteroids. The mean initial dose of prednisone was 0.8±0.2 mg/kg per day. High-dose corticosteroid treatment was maintained for 2 weeks (interquartile range, 1–4). After 6 months, the mean recovered GFR was 34±26 ml/min per 1.73 m 2 and ten patients required maintenance dialysis. Use of high-dose corticosteroids for 3 weeks or treatment duration >8 weeks were not associated with better recovery of kidney function. In the multivariable analysis, delayed onset of steroid treatment (odds ratio, 1.02; 95% confidence interval, 1.0 to 1.04) and the presence of interstitial fibrosis of >50% on the kidney biopsy specimen (odds ratio, 8.7; 95% confidence interval, 2.7 to 27.4) were both associated with serum creatinine level at month 6 of >75%, with respect to baseline values. Conclusions: High-dose corticosteroid treatment for 3 weeks or prolonged treatment for >8 weeks were not associated with greater kidney function recovery in drug-induced acute interstitial nephritis. A delay in the initiation of corticosteroids resulted in worse recovery of kidney function.
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“A recent case series published by Fernandez-Juarez et al. [27] demonstrated that the culprit drug cannot be precisely identified in nearly 30% of cases.”
From The diagnosis of acute interstitial nephritis caused by infection versus antibiotic-induced interstitial nephritis: a narrative review (2024) · cites this paper as [27]
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"Double whammy" to the kidneys: an unusual etiology of acute kidney disease
Jayaprakash, V., Suganya, M., Karthick, D., Kurien, A. A., & Padmanabhan, R. (2022) · Journal of Nephropathology · doi:10.34172/jnp.2022.17252 · Cited by 1
Mamlouk, O., Lin, J. S., & Abudayyeh, A. (2022) · Springer eBooks · doi:10.1007/978-3-031-00241-0_9 · Cited by 1
Tubulointerstitial Nephritis in Children
Verghese, P. S., Luckritz, K. E., & Eddy, A. A. (2023) · Springer eBooks · doi:10.1007/978-3-031-11665-0_42 · Cited by 1
Enfermedades renales tubulointersticiales. Conceptos generales. Formas agudas
de la Fuente, G. D. A., del Valle, K. M. P., Sevillano, B. H., & Gili, B. Q. (2019) · Medicine - Programa de Formación Médica Continuada Acreditado · doi:10.1016/j.med.2019.06.020
Drug-Induced Acute Tubulointerstitial Nephritis
Rădulescu, D. (2020) · Internal Medicine · doi:10.2478/inmed-2020-0127
Acute Drug-Allergic Tubulointerstitial Nephritis
Rădulescu, D. (2020) · Internal Medicine · doi:10.2478/inmed-2020-0140
Antibioterapia e insuficiencia renal aguda ¿causa o consecuencia?
Trallero, L. E. R., Gutiérrez, A. G., Alijarde, M. J. B., & Al-Cheikh-Felices, P. (2020) · Atalaya Médica Turolense
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Valencia, C. A. R., Martinez-Aristizábal, J.-D., & Flórez-Vargas, A. (2021) · Acta Médica Colombiana · doi:10.36104/amc.2021.2050
Dismal Prognosis of Acute Allergic Tubulointerstitial Nephritis in Patients with AA Amyloidosis
Yıldırım, T., Oguz, E. G., Koç, N., Uzerk-Kibar, M., Uner, M., Sağlam, E. A., Yılmaz, Ş., Aylı, D., & Erdem, Y. (2021) · Nephron · doi:10.1159/000520151
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Self-citationManagement of Tubulointerstitial Nephritis
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Metadata
- Authors
- Fernandez-Juarez, G., Perez, J. V., Caravaca-Fontán, F., Quintana, L., Shabaka, A., Rodriguez, E., Gadola, L., de Lorenzo, A., Cobo, M. A., Oliet, A., Sierra, M., Cobelo, C., Iglesias, E., Blasco, M., Galeano, C., Cordon, A., Oliva, J., Praga, M., & on behalf of the Spanish Group for the Study of Glomerular Diseases (GLOSEN)
- Affiliations
- Department of Nephrology, Hospital Fundación de Alcorcón, Madrid, Spain;
- Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain;
- Hospital Clínic de Barcelona (ES)
- Hospital Clínico San Carlos (ES)
- Department of Nephrology, Hospital del Mar, Barcelona, Spain;
- Universidad de la República de Uruguay (UY)
- Hospital Universitario de Getafe (ES)
- Department of Nephrology Hospital Universitario General de Canarias, Tenerife, Spain;
- Hospital Universitario Severo Ochoa (ES)
- Hospital San Pedro (ES)
- Hospital Universitario Lucus Augusti (ES)
- Department of Nephrology, Complejo Hospitalario Universitario de Orense, Orense, Spain;
- Hospital Universitario Ramón y Cajal (ES)
- Hospital Universitario Fundación Alcorcón (ES)
- Instituto de Salud Carlos III (ES)
- Hospital Universitario 12 De Octubre (ES)
- ORCID
- Venue
- Clinical Journal of the American Society of Nephrology
- Published
- 2018-11-05
- Volume
- 13
- Issue
- 12
- Pages
- 1851-1858
- ISSN
- 1555-9041 (ISSN-L)
- 1555-905X
- PMC
- PMC6302327
- OpenAlex
- W2900322133
- Cited by
- 133
- References
- 19
- Citations by year
- 2026: 11 · 2025: 19 · 2024: 16 · 2023: 13 · 2022: 29 · 2021: 14 · 2020: 18 · 2019: 10 · 2018: 2
- FWCI
- 9.02
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Clinical Journal of the American Society of Nephrology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, other-oa)
- 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 treatment duration, renal function recovery, acute kidney injury, prednisone, nonsteroidal anti-inflammatory drugs, interstitial fibrosis, serum creatinine, chronic dialysis, elderly patients
- MeSH terms
- Acute Disease, Aged, Female, Glucocorticoids, Humans, Kidney, Kidney Function Tests, Male, Middle Aged, Nephritis, Interstitial, Prednisone, Retrospective Studies, Time Factors, Recovery of Function
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