Drug-Induced Acute Interstitial Nephritis: Report of 10 Cases

Abstract

10 patients with acute allergic interstitial nephritis were seen in a clinical nephrology service at a large regional hospital. The onset of renal failure was temporally related to the use of a drug: a nonsteroidal anti-inflammatory agent (NSAID) (in four patients), cimetidine (in three), antibiotics (in two) or allopurinol (in one). The onset of renal failure was acute in three patients and insidious in seven. Two patients also exhibited marked proteinuria. Clinical features such as fever, rash, hematuria, pyuria with or without eosinophiluria, and mild to marked proteinuria had led to suspicion of the disease. The diagnosis was confirmed by renal biopsy findings of inflammatory cells, predominantly lymphocytes, plasma cells and eosinophils. Three patients required hemodialysis; two of them received steroids as well. Steroid therapy was also used in two patients with NSAID-induced proteinuria. Renal function improved in nine patients by 35 days, but one patient continued to have slow but progressive deterioration of renal function. Acute interstitial nephritis can be distinguished from other forms of acute renal failure by heavy renal uptake of gallium 67, maximal 48 hours or more after injection. The improvement in renal function after discontinuation of the implicated drug, the characteristic histopathological findings of allergic interstitial nephritis, and the presence of eosinophils and sometimes IgE in the blood suggest a hypersensitivity reaction.De janvier 1979 k juin 1985 on observe dans le service de nephrologie d'un important h6pital regional 10 malades presentant une nephrite interstitielle aigue d'origine allergique. Il existe un rapport dans le temps entre le debut de l'insuffisance renale et la prise d'un medicament: quatre fois un anti-inflammatoire nonsteroldien (AINS), trois fois la cimetidine, deux fois un antibiotique et une fois l'allopurinol. Debut aigu chez trois malades et insidieux chez sept. Les manifestations d'appel sont la fibvre,

Acute tubulointerstitial nephritis, treatment with steroid and impact on renal outcomes

“…The evidence for the use of steroids to treat ATIN comes from small uncontrolled retrospective studies 5–9 with some reporting benefit and others showing no difference in outcome 10–13 . There is some evidence that steroids expedite initial recovery of renal function, although they may not influence longer‐term chronic kidney disease (CKD) 4 .…”

“…The evidence for the use of steroids to treat ATIN comes from small uncontrolled retrospective studies [5][6][7][8][9] with some reporting benefit and others showing no difference in Nephrology 17 (2012) 748-753 outcome. [10][11][12][13] There is some evidence that steroids expedite initial recovery of renal function, although they may not influence longer-term chronic kidney disease (CKD). 4 One recently published study has indicated the importance of early introduction of steroids to have an impact on renal outcome.…”

Renal Effects of Peptic Ulcer Therapy

“…These interactions with cimetidine are clinically significant because a decrease in drug clearance may lead to an increase in adverse effects, especially in the elderly and in those with impaired renal function. Numerous cases of acute interstitial nephritis have been reported with cimetidine therapy (Handa 1986;Kaye et al 1983;McGowan & Vermillion 1980;Richman et al 1981;Rudnick et al 1982). Renal biopsies of those cases all showed typical features of interstitial nephritis with infiltrates consisting of plasma cells, lymphocytes and eosinophils.…”

Azithromycin‐Induced, Biopsy‐Proven Acute Interstitial Nephritis in an Adult Successfully Treated with Low‐Dose Corticosteroids

“…A set of seven case series compared AIN treated with corticosteroids (52 patients) and without corticosteroids (48 patients) . Persistent renal dysfunction (S cr higher than 2.3 mg/dl) occurred in 17% of those treated with corticosteroids compared with 19% of those treated without corticosteroids (p value not reported).…”