Recurrent acute interstitial nephritis: what lies beneath
Por:
Caravaca-Fontan, F, Shabaka, A, Sanchez-Alamo, B, de Lorenzo, A, Diaz, M, Blasco, M, Rodriguez, E, Sierra-Carpio, M, Marin, T, Urrestarazu, A, Cases, C, Praga, M, Fernandez-Juarez, G and Spanish Grp Study Glomerular Dis G
Publicada:
1 ene 2021
Categoría:
Nephrology
Resumen:
Background. Acute interstitial nephritis (AIN) is an emerging cause of acute kidney disease. While this disease usually follows an acute course, it may occasionally recur, representing a major challenge for the clinician.
Methods. We performed a retrospective, observational cohort study in 13 nephrology departments belonging to the Spanish Group for the Study of Glomerular Diseases. Patients with biopsy-proven AIN between 1996 and 2018 were included.
Results. The study group consisted of 205 patients with AIN, 22 of which developed recurrent AIN (RAIN) after a median of 111 days from diagnosis. RAIN was due to a surreptitious reintroduction of a previously known implicated drug or toxic in six patients (27%), sarcoidosis in two (9%), Sjogren's syndrome in three (14%), light-chain-mediated AIN in two (9%) and tubulointerstitial nephritis and uveitis syndrome in two (9%), while in the rest of cases (32%), no precise cause could be identified. Microscopic haematuria was more frequent in patients with underlying systemic diseases. The first RAIN episode was treated with a repeated course of corticosteroids in 21 patients (95%). In six cases (27%), azathioprine and mycophenolate mofetil were added as corticosteroid-sparing agents. During a median follow-up of 30 months, 50 patients (27%) with no recurrences and 12 patients (55%) with RAIN reached Stages 4 and 5 chronic kidney disease (CKD). By multivariable logistic regression analysis, RAIN was independently associated with the risk of reaching Stages 4 and 5 CKD, even after adjusting for potential covariables.
Conclusions. RAIN is infrequent but is associated with poor kidney survival. RAIN should prompt clinicians to search for an underlying aetiology other than drug induced. However, in a large percentage of cases, no precise cause can be identified.
Filiaciones:
Caravaca-Fontan, F:
Hosp Univ 12 Octubre, Inst Invest, Dept Nephrol, Madrid, Spain
Univ Complutense Madrid, Dept Med, Madrid, Spain
Shabaka, A:
Hosp Univ Fdn Alcorcon, Dept Nephrol, Madrid, Spain
Sanchez-Alamo, B:
Hosp Univ Fdn Alcorcon, Dept Nephrol, Madrid, Spain
de Lorenzo, A:
Hosp Univ Getafe, Dept Nephrol, Madrid, Spain
Diaz, M:
Hosp Univ Ramon y Cajal, Dept Nephrol, Madrid, Spain
Blasco, M:
Univ Barcelona, Hosp Clin Barcelona, Dept Nephrol, Barcelona, Spain
Rodriguez, E:
Hosp del Mar, Dept Nephrol, Barcelona, Spain
Sierra-Carpio, M:
Hosp San Pedro, Dept Nephrol, Logrono, Spain
:
Hosp Sagunto, Dept Nephrol, Sagunto, Spain
Urrestarazu, A:
Hosp Clin Montevideo, Dept Nephrol, Montevideo, Uruguay
Cases, C:
Hosp Univ Fdn Alcorcon, Dept Nephrol, Madrid, Spain
Praga, M:
Hosp Univ 12 Octubre, Inst Invest, Dept Nephrol, Madrid, Spain
Univ Complutense Madrid, Dept Med, Madrid, Spain
Fernandez-Juarez, G:
Hosp Univ Fdn Alcorcon, Dept Nephrol, Madrid, Spain
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