[Acute interstitial nephritis caused by drug hypersensitivity. Current controversies]

Area of Science:

• Nephrology
• Clinical Immunology
• Pharmacology

Background:

• Acute interstitial nephritis (AIN) accounts for 0.8-8% of acute renal failure cases.
• Antibiotics (especially beta-lactams) and NSAIDs are primary causes of drug-induced AIN.
• Clinical signs like hypereosinophilia, fever, and arthralgias suggest allergic drug reactions in AIN patients.

Purpose of the Study:

• To review the diagnostic clues and management of acute interstitial nephritis (AIN) caused by drug hypersensitivity.
• To highlight the role of clinical presentation and renal biopsy in diagnosing drug-induced AIN.
• To discuss the impact of drug withdrawal and potential benefits of steroid therapy.

Main Methods:

• Review of existing literature on drug-induced acute interstitial nephritis.
• Analysis of diagnostic indicators including clinical symptoms and renal biopsy findings.
• Evaluation of treatment outcomes based on drug withdrawal and corticosteroid use.

Main Results:

• Drug hypersensitivity is a significant cause of AIN, with antibiotics and NSAIDs being common culprits.
• Key diagnostic indicators include blood hypereosinophilia, fever, arthralgias, and specific renal biopsy findings (eosinophilic infiltration, granulomas).
• Early diagnosis and prompt withdrawal of the offending drug are crucial for renal recovery.

Conclusions:

• Acute interstitial nephritis due to drug hypersensitivity requires prompt recognition and management.
• Clinical and histological findings are vital for diagnosing AIN.
• While drug withdrawal is key, the role of steroids in preventing long-term renal damage warrants further controlled studies.