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Interstitial Nephritis Induced by Repeated Nonsteroidal Anti-inflammatory Drugs (NSAIDs) Use for Persistent Fever: A
Norihito Yoshida1, Yusuke Suzuki1, Mai Hitaka1
1Nephrology, Toho University Sakura Medical Center, Sakura, JPN.
Cureus
|August 5, 2025
Summary
Nonsteroidal anti-inflammatory drug-induced acute interstitial nephritis (DI-AIN) can cause kidney injury. Elevated urinary tubular markers, not just proteinuria, signal DI-AIN, and early steroid treatment may aid recovery.
Area of Science:
- Nephrology
- Pharmacology
- Internal Medicine
Background:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used for pain and inflammation but can cause kidney damage, specifically drug-induced acute interstitial nephritis (DI-AIN).
- Early diagnosis and management of DI-AIN are crucial to prevent permanent kidney damage.
Observation:
- A 46-year-old male developed acute kidney injury (AKI) after daily ibuprofen use.
- Despite stopping ibuprofen, his kidney function did not improve, showing elevated urinary tubular injury markers (NAG, β2MG, L-FABP) with only mild proteinuria.
- A kidney biopsy was performed, and empirical steroid therapy was initiated before biopsy confirmation due to strong clinical suspicion.
Findings:
- Empirical steroid treatment led to improved serum creatinine levels before biopsy results were available.
- Kidney biopsy confirmed acute interstitial nephritis (AIN).
- The patient achieved sustained renal function recovery after a 10-month steroid taper.
Implications:
- This case highlights the importance of considering DI-AIN in patients with AKI and NSAID exposure.
- Elevated urinary tubular markers, even with mild proteinuria, can be a key diagnostic indicator for DI-AIN.
- Early, empirically guided steroid therapy may be beneficial in DI-AIN cases, though kidney biopsy remains essential for definitive diagnosis.
- Enhanced patient education on appropriate NSAID use is critical to prevent DI-AIN.
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