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Acute tubulointerstitial nephritis in Scotland.
A Valluri1, L Hetherington1, E Mcquarrie1
1From the Department of Renal Medicine, Ninewells Hospital & Medical School, Dundee, DD1 9SY, Glasgow Renal & Transplant Unit, Western Infirmary, Dumbarton Road, Glasgow, G11 6NT, Department of Pathology, Ninewells Hospital & Medical School, Dundee, DD1 9SY and Department of Pathology, Western Infirmary, Glasgow, G11 6NT, UK.
QJM : Monthly Journal of the Association of Physicians
|December 1, 2014
Summary
Acute tubulointerstitial nephritis (ATIN) is increasingly diagnosed, often drug-induced. Corticosteroid treatment showed no significant benefit for kidney recovery in this study.
Area of Science:
- Nephrology
- Internal Medicine
- Pharmacology
Background:
- Acute tubulointerstitial nephritis (ATIN) is a key cause of acute kidney injury.
- The majority of ATIN cases are linked to medications.
- Understanding ATIN incidence and treatment impact is crucial.
Purpose of the Study:
- To determine the incidence and etiological profile of biopsy-proven ATIN in Scotland.
- To evaluate the effectiveness of corticosteroid treatment in ATIN patients.
Main Methods:
- Retrospective analysis of 171 adult patients with biopsy-proven ATIN from 2000-2012.
- Data collected included demographics, clinical presentation, etiology, pathology, treatment, and outcomes.
- Comparison of outcomes between patients treated with corticosteroids and those managed conservatively.
Main Results:
- ATIN incidence rose, with 73% of cases being drug-induced.
- Proton pump inhibitors (PPIs) and antibiotics were equally implicated (35% each), surpassing NSAIDs (20%).
- Corticosteroid treatment did not improve renal recovery rates or reduce dialysis dependence compared to conservative management.
Conclusions:
- Biopsy-proven ATIN incidence is increasing in Scotland, predominantly due to drug exposure.
- Current evidence does not support the routine use of corticosteroids for treating drug-induced ATIN.
- Further research is needed to identify optimal ATIN management strategies.
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