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

Abstract

BACKGROUND:

The use and timing of steroids in the management of acute tubulointerstitial nephritis (ATIN) remains debatable.

AIMS:

To determine the incidence and aetiology of ATIN in our unit, and to examine trends in the use of steroids and their impact on renal outcomes.

METHODS:

Patients with a histological diagnosis of ATIN over a 9-year period were identified and divided into steroid-treated (StG) and steroid-naïve groups (SnG). Mean change in estimated glomerular filtration rate (eGFR) was determined.

RESULTS:

Forty-nine patients had ATIN as their main diagnosis, 67% of cases were drug-induced, and proton pump inhibitors (PPI) were the second commonest implicated drug category. Majority (75%) of patients received steroids, and eGFR improved to a significantly greater degree in these steroid-treated patients (3.4-fold improvement vs 2.0-fold in SnG; P < 0.05, unpaired t-test). Despite comparable eGFR at presentation (StG: 11.7; SnG: 15.4), steroid-treated patients were less likely to receive dialysis, although not significantly so (OR 0.27; 95% CI 0.06-1.15, P = 0.066, chi-squared test). However, there was no significant relation between the degree of eGFR improvement and delay in starting steroids (Pearson r = -0.25, P > 0.45), and no difference in eGFR at the time of last follow-up (StG: 33 ± 3; SnG: 32 ± 7; P > 0.9, unpaired t-test).

CONCLUSION:

StG patients had a greater degree of improvement in renal function, but with no correlation between degree of improvement in eGFR and delay in starting steroids, and similar eGFR values at final follow-up. PPI were the second commonest drug category among drug-induced cases.

• Authors: Muhammad N Raza, Muhammad Hadid, Charles E Keen, Coralie Bingham, Andrew H J Salmon
• Journal: Nephrology (Carlton, Vic.) (Nephrology (Carlton)) Vol. 17 Issue 8 Pg. 748-53 (Nov 2012) ISSN: 1440-1797 [Electronic] Australia
• PMID: 22817666 (Publication Type: Journal Article)
• Copyright: © 2012 The Authors. Nephrology © 2012 Asian Pacific Society of Nephrology.

Chemical References

• Anti-Bacterial Agents
• Proton Pump Inhibitors
• Steroids

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Anti-Bacterial Agents (adverse effects)
• Biopsy
• Chi-Square Distribution
• England (epidemiology)
• Female
• Glomerular Filtration Rate (drug effects)
• Humans
• Incidence
• Kidney (drug effects, pathology, physiopathology)
• Male
• Middle Aged
• Nephritis, Interstitial (diagnosis, drug therapy, epidemiology, physiopathology)
• Odds Ratio
• Proton Pump Inhibitors (adverse effects)
• Recovery of Function
• Renal Dialysis
• Retrospective Studies
• Risk Factors
• Steroids (therapeutic use)
• Time Factors
• Treatment Outcome
• Young Adult