Acute interstitial nephritis in adolescents and young adults

We have reviewed our experience with acute interstitial nephritis (AIN) in pediatric patients over the 3-year period from 1985 to 1988. We encountered 7 new cases of AIN in this interval and it was seen in 7% of kidney biopsies performed during this time of study. The clinical presentation was very nonspecific and included fever (100%), gastrointestinal complaints (57%) and rash (28%). Laboratory findings on admission included elevated erythrocyte sedimentation rate (100%), anemia (70%), pyuria (57%) and abnormal renal ultrasound (86%). Associated systemic diseases were observed in 4 patients. AIN was severe enough to necessitate treatment with hemodialysis in 42% of the cases. Corticosteroid therapy was used in 6 patients with a favorable response in all but 1 case. While 6/7 patients manifested complete recovery, 1 adolescent who may have had pre-existing renal disease had persistent chronic renal failure (estimated GFR, 25 l/min/1.73 m2). We have concluded that: (1) AIN is a relatively common disease in pediatric practice; (2) it can be severe enough to necessitate dialysis therapy, and (3) AIN often occurs in children with systemic disorders that may be associated with immunologic disorders.