[Acute interstitial nephritis caused by drugs]

Area of Science:

• Nephrology
• Pharmacology
• Pathology

Background:

• Acute kidney injury (AKI) of unknown etiology poses diagnostic challenges.
• Drug-induced acute interstitial nephritis (DI-AIN) is a significant cause of AKI.
• Identifying specific causative agents is critical for patient management.

Purpose of the Study:

• To investigate the clinical presentation and diagnostic features of drug-induced acute interstitial nephritis.
• To evaluate the role of percutaneous renal biopsy in diagnosing DI-AIN.
• To assess the outcomes of patients with DI-AIN and identify risk factors for irreversible renal failure.

Main Methods:

• Retrospective analysis of ten patients diagnosed with DI-AIN over 30 months.
• Clinical data collection including renal function, urinalysis, and treatment modalities.
• Definitive diagnosis confirmed by percutaneous renal biopsy.

Main Results:

• Ten patients diagnosed with DI-AIN, with varied causative agents including antibiotics and other derivatives.
• Clinical presentation often undramatic, characterized by non-oliguric renal failure, leucocyturia, microhaematuria, and moderate proteinuria.
• Intermittent hemodialysis required in 50% of cases; renal function improved but plasma creatinine often remained elevated.

Conclusions:

• Drug-induced acute interstitial nephritis can have subtle clinical signs, differing from methicillin-induced nephritis.
• Percutaneous renal biopsy is a definitive diagnostic tool for unclear acute renal failure.
• Liberal use of renal biopsy is recommended to prevent irreversible kidney damage from continued drug exposure.