Changes in the aetiology, clinical presentation and management of acute interstitial nephritis, an increasingly common cause of acute kidney injury

Abstract

Acute interstitial nephritis (AIN) is an important cause of acute kidney injury that has experienced significant epidemiological and clinical changes in the last years. The classical presentation, mostly induced by antibiotics and accompanied by evident hypersensitivity manifestations (skin rash, eosinophilia, fever) has been largely replaced by oligosymptomatic presentations that require a higher index of suspicion and are increasingly recognized in the elderly, having non-steroidal anti-inflammatory agents and proton pump inhibitors as frequent offending drugs. Drug-induced AIN continues to be the commonest type, but it requires a careful differential diagnosis with other entities (tubulointerstitial nephritis with uveitis syndrome, IgG4-related disease, drug reaction with eosinophilia and systemic symptom syndrome, sarcoidosis and other systemic diseases) that can also induce AIN. Cortico-dependant, relapsing AIN is a recently recognized entity that poses an important therapeutic challenge. Although corticosteroids are widely used in drug-induced AIN to speed kidney function recovery and avoid chronic kidney disease, their efficacy has not been tested by randomized controlled trials. New diagnostic tests and biomarkers, as well as prospective therapeutic studies are needed to improve AIN diagnosis and management.

An unexpected complication of chronic myelomonocytic leukemia: severe renal failure due to malignant tubulo-interstitial cell infiltration

“…Yet, outcome results are conflicting, and many issues remain unanswered (eg, mechanism of action) or topic of debate (eg, optimal dose and duration of therapy). 11 Our patient responded well to a treatment combining high-dose steroids and hydroxycarbamide. Unless formally contraindicated (eg, infection-induced ATIN), steroid therapy should be considered in patients with ATIN whose kidney function fails to improve after attempting to control or eliminate the culprit disease or if vasculitis is evidenced.…”

Identifying Patient Candidates for IL-1 Inhibition: Lessons From Real-World Cases

“…However, NSAIDs should not be used in patients with acute kidney injury [40], and colchicine therapy is associated with significant side effects, namely gastrointestinal (GI) side effects. Despite presenting with GI symptoms on admission, our patient was initially treated with low-dose allopurinol and colchicine.…”

“…Gouty arthritis is generally characterized by intense episodes of painful swelling in single joints, most often in the big toe, that appear red and warm [39]. Tissue deposition of urate crystals in the interstitial space of the kidneys can also lead to renal failure as a result of supersaturation of extracellular fluids with urate [40].…”

Interstitielle Nephritis bei rheumatischen Erkrankungen

“…Die Prävalenz der CIN bei Patienten mit terminaler Niereninsuffizienz liegt nach den Daten der "Quasi-Niere"-Studie für das Jahr 2006 bei 12% [12]. Gepoolte Registerdaten aus allen Teilen der Welt geben eine Häufigkeit der akuten Formen zwischen 0,5-2,6% bezogen auf alle Nierenbiopsien an [41]. Liegt ein akutes Nierenversagen vor, ist die Häufigkeit mit 5-18% deutlich höher [41].…”

“…Gepoolte Registerdaten aus allen Teilen der Welt geben eine Häufigkeit der akuten Formen zwischen 0,5-2,6% bezogen auf alle Nierenbiopsien an [41]. Liegt ein akutes Nierenversagen vor, ist die Häufigkeit mit 5-18% deutlich höher [41]. Spanischen Registerdaten zufolge mit 17.680 Biopsien aus den Jahren 1994-2009 ist die Prävalenz der AIN zunehmend (von 3% auf ca.…”