Etiology and renal outcomes of acute tubulointerstitial nephritis: a single-center prospective cohort study in China

Abstract

Our data demonstrate that autoimmune-related ATIN may present with systemic manifestations after kidney injury and is, therefore, commonly misdiagnosed. Repeated kidney injury is not uncommon in patients with ATIN. Scheduled follow-up is, therefore, critical for defining the exact etiology and proper management of ATIN.

HLA-DQA1, -DQB1, and -DRB1 Alleles Associated with Acute Tubulointerstitial Nephritis in a Chinese Population: A Single-Center Cohort Study

“…In SS, IgG4-RD, and ATIN because of other causes, this susceptibility in HLA-DQA1, -DQB1, and -DRB1 alleles was not detected nor has it been reported elsewhere. Our recently published study found that 60% of patients with TINU syndrome had a history of taking causative drugs, presented allergic symptoms, and had late-onset uveitis (29). Other researchers have also reported cases of TINU syndrome induced by drugs (30) as well as positive drug-specific lymphocyte stimulating tests (31).…”

Perspectives on acute kidney injury strategy in China

“…Acute tubulointerstitial nephritis accounts for 1–3% of all renal biopsies and represents one of the most common pathological changes contributing to renal parenchymal AKI in biopsied settings, with an increasing trend reported in recent years . In a recent published prospective cohort study that enrolled 157 cases of biopsy‐proven ATIN with various etiologies, a changing etiologic spectrum during the disease follow‐up course was reported . At the time of renal biopsy, 64.3% of the cases were identified as drug‐induced ATIN and autoimmune diseases were diagnosed in 22.3% of the patients.…”

“…The major reason for this change was the misdiagnosis of tubulointerstitial nephritis and uveitis (TINU) syndrome, a previously thought rare autoimmune‐related ATIN, at the time of renal biopsy (8.9–22.3%). Of the patients whose final diagnosis was TINU syndrome, 60.0% had late‐onset uveitis and therefore were misclassified as drug‐induced ATIN since many of these had taken various medications before and during the onset of their diseases …”

“…14 In a recent published prospective cohort study that enrolled 157 cases of biopsy-proven ATIN with various etiologies, a changing etiologic spectrum during the disease followup course was reported. 15 At the time of renal biopsy, 64.3% of the cases were identified as drug-induced ATIN and autoimmune diseases were diagnosed in 22.3% of the patients. During follow up, the causes of ATIN were redefined and these reclassifications led to a change in the etiological spectrum, with a decreased proportion of drug-induced ATIN to 50.3% and an increased proportion of autoimmune diseases to 41.4%.…”

“…Of the patients whose final diagnosis was TINU syndrome, 60.0% had late-onset uveitis and therefore were misclassified as drug-induced ATIN since many of these had taken various medications before and during the onset of their diseases. 15 This change in the etiologic spectrum of ATIN leads to a modification of clinical diagnosis and immunosuppression therapy, especially for patients with TINU syndrome, as patients in this clinical setting tend to have recurrent AKI during follow up, which would then lead to a worse longterm renal outcome compared with those of drug-induced ATIN. A regular slit-lamp examination at the time of the renal biopsy could increase the detection rate of TINU syndrome from 5% to 9%.…”