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Cited by 133Acute Kidney Injury ResearchNephrotoxicity and Medicinal PlantsRenal Diseases and Glomerulopathies

The DOI matches its Crossref record; 19 of the 19 references it cites were found in a registry or an index.

Duration of Treatment with Corticosteroids and Recovery of Kidney Function in Acute Interstitial Nephritis

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Fernandez-Juarez, Gema, Perez, Javier Villacorta, Caravaca-Fontán, Fernando, Quintana, Luis, Shabaka, Amir, Rodriguez, Eva, Gadola, Liliana, de Lorenzo, Alberto, Cobo, Maria Angeles, Oliet, Aniana, Sierra, Milagros, Cobelo, Carmen, Iglesias, Elena, Blasco, Miguel, Galeano, Cristina, Cordon, Alfredo, Oliva, Jesus, Praga, Manuel, on behalf of the Spanish Group for the Study of Glomerular Diseases (GLOSEN)·2018·Clinical Journal of the American Society of Nephrology
DOI 10.2215/cjn.01390118PMC PMC6302327
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Abstract

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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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
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2018-11-05
Volume
13
Issue
12
Pages
1851-1858
ISSN
  • 1555-9041 (ISSN-L)
  • 1555-905X
DOI
10.2215/cjn.01390118
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
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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