scholarly journals Inflammatory leucocyte infiltrates are associated with recovery in biopsy-proven acute interstitial nephritis: a 20-year registry-based case series

2019 ◽  
Vol 12 (6) ◽  
pp. 814-820 ◽  
Author(s):  
Ralph Wendt ◽  
Jennifer Schliecker ◽  
Joachim Beige
Keyword(s):  
Renal Function ◽  
Interstitial Nephritis ◽  
Case Series ◽  
Acute Interstitial Nephritis ◽  
Lower Probability ◽  
Data Set ◽  
Renal Function Deterioration ◽  
Outcome Criterion ◽  
Histological Activity ◽  
Underlying Diseases

Abstract Background Acute interstitial nephritis (AIN) is a renal injury causing renal function deterioration and requiring renal replacement therapy (RRT) in a substantial number of cases. Therapy is based on withdrawal of suspicious causative drugs or the underlying diseases and/or steroid application if renal function is not restored after cessation of the underlying condition. Hard clinical evidence for augmenting steroid therapy is not available. Methods We reviewed the course and diagnosis for >20 years among all 1126 biopsied samples of our tertiary renal centre. Results 49 (4.4%) were diagnosed with primary AIN, corresponding to an annual incidence of 1/100 000 population; 17 out of 49 biopsy-proven AIN patients required short-term or long-term (n = 5) RRT. According to a combined outcome criterion of coming off dialysis and/or reaching serum creatinine <200 µmol/L, 19 patients reached recovery whereas 20 did not. Among 39 patients with a comprehensive clinical and histopathological data set, presence of cortical scars, AIN histological activity (acute leucocyte infiltrates) and proteinuria were baseline parameters discriminating significantly between groups with or without recovery. No associations with the presence of specific drugs were found. Therapeutic use of steroids was associated with a lower probability of recovery (P = 0.008), presumably due to inclusion bias. Conclusions Following our basic finding of the importance of histopathological parameters of acuity associated with recovery, we argue for the inauguration of grading measures to characterize this issue quantitatively and make it usable for future controlled investigations. Finally, we provide a suggestion for a therapeutic algorithm in the management of AIN.

scholarly journals The mechanisms of acute interstitial nephritis in the era of immune checkpoint inhibitors in melanoma

2019 ◽  
Vol 11 ◽  
pp. 175883591987554 ◽  
Author(s):  
Marco Tucci ◽  
Anna Passarelli ◽  
Annalisa Todisco ◽  
Francesco Mannavola ◽  
Luigia Stefania Stucci ◽  
...  
Keyword(s):  
Renal Function ◽  
Interstitial Nephritis ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Acute Interstitial Nephritis ◽  
Clinical State ◽  
High Dose ◽  
Systemic Symptoms ◽  
The Impact

Treatment with immune checkpoint inhibitors (ICIs) has improved the prognosis of patients with a number of types of cancer, but the frequent development of immune-related adverse effects (irAEs) can worsen the outcome. The most common irAEs involve the gastrointestinal, cutaneous, and endocrine systems, but nephrotoxicity, resulting from damage to the tubule-interstitial compartment, may occur in some patients. The early phases of acute interstitial nephritis (AIN) are characterized by systemic symptoms that indicate a poor clinical state as well as a mild deterioration of renal function. Tubular injury is due to a direct effect mediated by cytotoxic CD8+ T cells, which sustain the local production of pro-inflammatory cytokines that progressively impair renal function. The treatment of AIN is mainly based on high-dose steroids, which in most instances leads to the recovery of renal function. However, the premature discontinuation of ICI therapy may prevent the impact of treatment on the clinical progression of the malignancy. Adequately addressing irAEs requires a standardized therapy that is based on the results of large clinical trials.

Delayed Renal Function Recovery From Drug-Induced Acute Interstitial Nephritis

2012 ◽  
Vol 343 (1) ◽  
pp. 36-39 ◽  
Author(s):  
Dongmei Chen ◽  
Chunlei Luo ◽  
Zheng Tang ◽  
Yan Zhou ◽  
Huiping Chen ◽  
...  
Keyword(s):  
Renal Function ◽  
Interstitial Nephritis ◽  
Acute Interstitial Nephritis ◽  
Drug Induced ◽  
Renal Function Recovery ◽  
Function Recovery

scholarly journals Longterm renal outcome of biopsy-proven acute tubular necrosis and acute interstitial nephritis

2019 ◽  
Author(s):  
Hyunseo Kim ◽  
Sang Kyung ◽  
Shin Young Ahn ◽  
Young Joo Kwon ◽  
Hajeong Lee ◽  
...  
Keyword(s):  
Renal Function ◽  
Interstitial Nephritis ◽  
Acute Tubular Necrosis ◽  
Female Gender ◽  
Acute Interstitial Nephritis ◽  
Renal Outcome ◽  
Pathological Features ◽  
University Hospitals ◽  
Glomerular Diseases ◽  
Tubular Necrosis

Abstract Background: Although emerging evidence suggest acute kidney injury (AKI) progress to chronic kidney disease (CKD), longterm renal outcome of AKI still remains unclear. Unlike glomerular diseases, AKI is usually diagnosed in the clinical context without kidney biopsies, and lack of histology might contribute to this uncertainty. Acute tubular necrosis (ATN) is the most common cause of AKI due to ischemia, toxin or sepsis. Acute interstitial nephritis (AIN), caused by drugs or autoimmune diseases is also increasingly recognized as an important cause of AKI. Methods: Among 8,769 biopsy series, 253 adults who were histologically diagnosed with ATN and AIN from 1982 to 2018 at five university hospitals were included. Demographic and pathological features that are associated with the development of end stage renal disease (ESRD) were also examined. Results: Rate of non-recovery of renal function at 6 month was significantly higher in the AIN (ATN vs AIN 49.3 vs 69.4%, p=0.007) with a 2.709-fold higher risk of non- recovery compared to ATN (95% CI: 1.203–6.470). During the mean follow up of 76.5±91.9 months, ESRD developed in 39.4% of patients with AIN, and 21.5% patients of ATN. The risk of ESRD was significantly higher in AIN (23.050; 95% CI: 2.420-219.533) and also in ATN (12.136; 95% CI, 1.186-24.235) compared to control with non-specific pathology. Older age, female gender, renal function at the time of biopsy and at 6 months, proteinuria and pathological features including interstitial inflammation and fibrosis, tubulitis, vascular lesion were significantly associated with progression to ESRD. Conclusions: Our study demonstrated that patients with biopsy proven ATN and AIN are at high risk of developing ESRD.

scholarly journals Acute interstitial nephritis with immunotherapy; a growing entity?

2020 ◽  
Vol 9 (4) ◽  
pp. e35-e35
Author(s):  
John David Chetwood ◽  
Lin Lin Myat ◽  
Helen Lammi ◽  
Mani Panat ◽  
James Hughes
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Interstitial Nephritis ◽  
Cancer Survival ◽  
Kidney Injury ◽  
Acute Interstitial Nephritis ◽  
Response To Treatment ◽  
Immune Mediated ◽  
Life Threatening ◽  
Potential Impact

We report a case of acute kidney injury (AKI) secondary to immune-mediated acute interstitial nephritis (AIN), with supporting diagnostic results and a successful response to treatment. This entity is gaining increasing recognition with the burgeoning use of immunotherapy agents in oncology. The timeline for the development of AIN from the initiation of immunotherapy varies, and may range in severity from asymptomatic to severe, organ-threatening and with life threatening consequences. Renal biopsy should be performed to confirm the diagnosis due to the potential impact of discontinuation of immunotherapy on cancer survival. Re-challenge with immunotherapy is reasonable once renal function recovers.

Clozapine-induced interstitial nephritis in a patient with schizoaffective disorder in the forensic setting: a case report and review of the literature

2019 ◽  
pp. 1-6
Author(s):  
C. McLoughlin ◽  
C. Cooney ◽  
R. Mullaney
Keyword(s):  
Renal Function ◽  
Interstitial Nephritis ◽  
Schizoaffective Disorder ◽  
Inflammatory Markers ◽  
Respiratory Symptoms ◽  
Rare Case ◽  
Psychiatric Symptoms ◽  
Acute Interstitial Nephritis ◽  
Review Of The Literature ◽  
Forensic Setting

We present a rare case of Acute Interstitial Nephritis (AIN) that occurred following a re-trial of clozapine in a 56-year-old lady with schizoaffective disorder. On initial trial of clozapine, this patient felt generally unwell with respiratory symptoms. Her inflammatory markers were raised and her renal function showed a mild, transient deterioration which normalised on the day of cessation of clozapine. Two years later, clozapine was re-trialled due the refractory nature of her psychiatric symptoms. She subsequently developed renal failure and AIN was confirmed by renal biopsy. Renal function improved after cessation of clozapine; however, she never fully regained normal renal function.

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