Chronic dialysis was required in 4 of 9 patients who did not receive steroids and in 2 of 52 steroid recipients — a significant difference.
Drugs are an important cause of acute interstitial nephritis (AIN). Although drug-induced AIN sometimes is treated with corticosteroids, no randomized trials have been conducted to evaluate this treatment. In this retrospective study, nephrologists in Spain assessed the effects of steroid therapy in 61 patients with biopsy-proven drug-induced AIN.
The most common offending agents were antibiotics (56%) and nonsteroidal anti-inflammatory drugs (37%); the presumed offending drug was stopped in all cases. Fifty-two patients received steroids, and 9 did not; no significant differences were noted between the groups in demographic characteristics, baseline serum creatinine levels, or highest serum creatinine level. Chronic dialysis was required in 4 of 9 patients who did not receive steroids and in 2 of 52 steroid recipients — a significant difference.
The authors also compared 28 steroid recipients whose renal function recovered completely and 24 steroid recipients whose final serum creatinine levels did not return to baseline (mean final creatinine level, 1.1 vs. 3.2 mg/dL). Steroid therapy had been initiated significantly earlier among patients with complete recovery than among patients with persistent renal dysfunction (mean interval between withdrawal of offending drug and onset of steroid therapy, 13 vs. 34 days).
Comment: Given the absence of randomized trials that address steroid therapy for drug-induced acute interstitial nephritis, we must rely on retrospective data. Some retrospective studies have suggested benefit (as did the current study), whereas others have not. The authors recommend starting steroids immediately after drug-induced AIN is diagnosed; however, other authorities recommend steroids only when serum creatinine levels do not improve within several days after withdrawal of the offending drug.
— Allan S. Brett, MD
Published in Journal Watch General Medicine May 6, 2008
González E et al. Early steroid treatment improves the recovery of renal function in patients with drug-induced acute interstitial nephritis. Kidney Int 2008 Apr; 73:940.