Recurrent acute interstitial nephritis: what lies beneath

Caravaca Fontán, Fernando; Shabaka, Amir; Sánchez Álamo, Beatriz; Lorenzo, Alberto de; Díaz, Martha; Blasco Pelícano, Miquel; Rodríguez, Eva; Sierra Carpio, Milagros; Malek Marín, Tamara; Urrestarazú, Andrés; Corona Cases, Clara; Praga, Manuel; Fernández Juárez, Gema; Spanish Group for the Study of Glomerular Diseases (GLOSEN)

Recurrent acute interstitial nephritis: what lies beneath

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dc.contributor.author Caravaca Fontán, Fernando
dc.contributor.author Shabaka, Amir
dc.contributor.author Sánchez Álamo, Beatriz
dc.contributor.author Lorenzo, Alberto de
dc.contributor.author Díaz, Martha
dc.contributor.author Blasco Pelícano, Miquel
dc.contributor.author Rodríguez, Eva
dc.contributor.author Sierra Carpio, Milagros
dc.contributor.author Malek Marín, Tamara
dc.contributor.author Urrestarazú, Andrés
dc.contributor.author Corona Cases, Clara
dc.contributor.author Praga, Manuel
dc.contributor.author Fernández Juárez, Gema
dc.contributor.author Spanish Group for the Study of Glomerular Diseases (GLOSEN)
dc.date.accessioned 2021-04-22T06:55:26Z
dc.date.available 2021-04-22T06:55:26Z
dc.date.issued 2020
dc.description.abstract 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%), Sjögren'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.
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dc.identifier.citation Caravaca-Fontán F, Shabaka A, Sánchez-Álamo B, de Lorenzo A, Díaz M, Blasco M, Rodríguez E, Sierra-Carpio M, Malek Marín T, Urrestarazú A, Corona Cases C, Praga M, Fernández-Juárez G; Spanish Group for the Study of Glomerular Diseases (GLOSEN). Recurrent acute interstitial nephritis: what lies beneath. Clin Kidney J. 2020;14(1):197-204. DOI: 10.1093/ckj/sfaa018
dc.identifier.doi http://dx.doi.org/10.1093/ckj/sfaa018
dc.identifier.issn 2048-8505
dc.identifier.uri http://hdl.handle.net/10230/47186
dc.language.iso eng
dc.publisher Oxford University Press
dc.relation.ispartof Clin Kidney J. 2020;14(1):197-204
dc.rights © The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
dc.rights.accessRights info:eu-repo/semantics/openAccess
dc.rights.uri http://creativecommons.org/licenses/by-nc/4.0/
dc.subject.keyword Acute interstitial nephritis
dc.subject.keyword Chronic kidney disease
dc.subject.keyword Recurrent acute interstitial nephritis
dc.title Recurrent acute interstitial nephritis: what lies beneath
dc.type info:eu-repo/semantics/article
dc.type.version info:eu-repo/semantics/publishedVersion

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