Acute interstitial nephritis â a reappraisal and update
Open accessAbstract
Acute interstitial nephritis (AIN) is an under recognized and under diagnosed cause of acute kidney injury (AKI). It is estimated to account for 15 - 20% of cases of AKI; it is the reported diagnosis in 2.8% of all kidney biopsies, and 13.5% of biopsies done specifically for acute renal failure. Considerable evidence implicates antigen initiated cell-mediated injury in the pathogenesis of AIN. Drugs account for 70% of all cases, with over 150 different agents incriminated. The remaining cases are due to infections, autoimmune diseases, and rarely idiopathic. The central component of renal injury in AIN is altered tubular function, which usually precedes decrements in filtration rate. The key to early diagnosis is vigilance for the presence of tubular dysfunction in non-oliguric individuals, especially in patients with modest but gradual increments in creatinine level. The utility of urinary biomarkers to diagnose AIN in its early nascent and potentially reversible stage remains to be determined. Prompt recognition, elimination of the offending source of antigen, and use of a limited course of steroid therapy where indicated, will result in complete resolution in ~ 65% of cases, partial resolution in up to 20%, and irreversible damage in the rest.
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Antibiotic-related AIN may require use of alternative antibiotic drugs along with application of an immunosuppressant.
“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 [6]
Up to 10%-27% of hospitalized AKI patients are affected by AIN, making it the third most prevalent cause of hospital-acquired AKI after acute tubular necrosis and prerenal AKI.
“It is estimated that up to 10%–27% of hospitalized AKI patients are affected by AIN, making it the third most prevalent cause of hospital-acquired AKI after acute tubular necrosis (ATN) and prerenal AKI [4–9].”
From The diagnosis of acute interstitial nephritis caused by infection versus antibiotic-induced interstitial nephritis: a narrative review (2024) · cites this paper as [6]
Raghavan et al. revealed a significant amount of neutrophilic infiltration that tends to be negative on immunofluorescence microscopy.
“The study conducted by Raghavan et al. [6] revealed a significant amount of neutrophilic infiltration, which tends to be negative on immunofluorescence microscopy.”
From The diagnosis of acute interstitial nephritis caused by infection versus antibiotic-induced interstitial nephritis: a narrative review (2024) · cites this paper as [6]
The amoxicillin-clavulanate case demonstrates an idiosyncratic immune response, with no correlation between the dose or duration of therapy.
“This case demonstrates an idiosyncratic immune response, with no correlation between the dose or the duration of amoxicillin–clavulanate therapy [6, 14, 77].”
From The diagnosis of acute interstitial nephritis caused by infection versus antibiotic-induced interstitial nephritis: a narrative review (2024) · cites this paper as [6]
Several studies have reported a higher level of neutrophils in infection-induced AIN.
“Furthermore, several studies have reported a higher level of neutrophils in infection-induced AIN [6].”
From The diagnosis of acute interstitial nephritis caused by infection versus antibiotic-induced interstitial nephritis: a narrative review (2024) · cites this paper as [6]
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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., et al. (2018) · Clinical Journal of the American Society of Nephrology · doi:10.2215/cjn.01390118 · Cited by 133 · see citing works
Mechanisms of Drug-Induced Interstitial Nephritis
Raghavan, R., & Shawar, S. (2017) · Advances in Chronic Kidney Disease · doi:10.1053/j.ackd.2016.11.004 · Cited by 117 · see citing works
Self-citationClinical 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
Effect of steroids and relevant cytokine analysis in acute tubulointerstitial nephritis
Yun, D., Jang, M.-J., An, J. N., Lee, J. P., Kim, D. K., Chin, H. J., Kim, Y. S., Lee, D.-S., & Han, S. S. (2019) · BMC Nephrology · doi:10.1186/s12882-019-1277-2 · Cited by 22 · see citing works
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
Badurdeen, Z., Ratnatunga, N., Abeysekera, T., Wazil, A. W. M., Rajakrishna, P. N., Thinnarachchi, J. P., Welagedera, D. D., Ratnayake, N., Alwis, A. P. D., Abeysundara, H., et al. (2023) · Trials · doi:10.1186/s13063-022-07056-4 · Cited by 6 · see citing works
Infection associated acute interstitial nephritis; a case report
Raina, R., Ale, S., Chaturvedi, T., Fraley, L., Novak, R., & Tanphaichitr, N. (2016) · Journal of Nephropathology · doi:10.15171/jnp.2017.09 · Cited by 4 · see citing works
- Authors
- Raghavan, R., & Eknoyan, G.
- Venue
- Clinical Nephrology
- Publisher
- Dustri-Verlgag Dr. Karl Feistle
- Published
- 2014-09-01
- Volume
- 82
- Issue
- 09
- Pages
- 149-162
- ISSN
- 0301-0430 (ISSN-L)
- PMC
- PMC4928030
- OpenAlex
- W4233072320
- Cited by
- 180
- References
- 1
- Citations by year
- 2026: 5 · 2025: 16 · 2024: 12 · 2023: 21 · 2022: 23 · 2021: 20 · 2020: 24 · 2019: 25 · 2018: 11 · 2017: 14 · 2016: 3 · 2015: 6
- FWCI
- 6.06
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- cc-by
- Locations
- Clinical Nephrology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- PubMed
- 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, drug-induced nephrotoxicity, interstitial nephritis, drug hypersensitivity, renal inflammation
- MeSH terms
- Biopsy, Glomerular Filtration Rate, Humans, Kidney, Nephritis, Interstitial, Predictive Value of Tests, Remission Induction, Risk Factors, Steroids, Prevalence, Treatment Outcome, Disease Progression, Early Diagnosis, Acute Kidney Injury
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