scholarly journals P0196ACUTE TUBULOINTERSTITIAL NEPHRITIS (ATIN) INDUCED BY CHECKPOINT INHIBITORS (ICI) VERSUS CLASSICAL ATIN. ARE THEY THE SAME DISEASE?

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Laura Martinez Valenzuela ◽  
Juliana Draibe ◽  
Clara Garcia Carro ◽  
Irene Agraz ◽  
Xavier Fulladosa ◽  
...  
Keyword(s):  
Tubulointerstitial Nephritis ◽  
Checkpoint Inhibitors ◽  
Laboratory Data ◽  
Specific Treatment ◽  
Latency Period ◽  
Response To Treatment ◽  
Acute Tubulointerstitial Nephritis ◽  
Diagnostic Time ◽  
Renal Histology

Abstract Background and Aims The incidence of acute tubulointerstitial nephritis (ATIN) related to drugs has dramatically increased during the past years. A new subtype of ATIN apparently different from classical drug related ATIN has emerged, which has been related to the administration of immune check point inhibitors (ICI). We herein investigated these differences between ICI related ATIN and non-ICI related ATIN, in terms of clinical features, response to treatment with steroids, and the kidney function evolution. Method A total of 47 patients diagnosed with acute tubulointerstitial nephritis (ATIN) from two centers were recruited. Of these, 13 patients presented with ATIN during the treatment with ICI, and 34 patients were diagnosed with ATIN attributed to other drugs. The main demographical, clinical and analytical variables such as gender, age, and current medication were recorded. The type of malignancy, oncological treatment, dose of ICI, and presence of extra-renal immune-related adverse-events were also reviewed. Renal biopsy diagnostic, time to drug withdrawal and ATIN specific treatment, as well as laboratory data during the follow-up were also studied. Results Patients diagnosed with ICI related ATIN presented with lower creatinine (ICI ATIN 3.8±1.03mg/dl vs. classical ATIN 5.98±4.15, p=0.007) at diagnostic and higher urinary leukocyte count (ICI ATIN 263.2±418.04 vs. classical ATIN 133.55±284.62, p=0.048) as compared to patients with non-ICI related ATIN. Time elapsed from the initiation of the culprit drug to the ATIN diagnostic was longer in ICI ATIN compared to classical ATIN (197.07±184.99 vs 114.4±352.16 days, p=0.006). In addition, during follow-up, the slope of decreasing creatinine over time was lower in ICI related ATIN compared to non-ICI related patients. Conclusion In this study we analyzed the differences between ICI ATIN and the classical ATIN. We found that ICI ATIN patients presented a larger latency period after offending drug initiation, milder acute kidney injury, and slower creatinine amelioration as compared to the classical ATIN. These results may be in part ascribed to potential differences in the pathological mechanisms in ATIN development, suggesting that ICI ATIN and the classical ATIN may be different disease with similar renal histology.

scholarly journals Acute tubulointerstitial nephritis induced by checkpoint inhibitors versus classical acute tubulointerstitial nephritis: are they the same disease?

2020 ◽  
Author(s):  
Juliana B Draibe ◽  
Clara García-Carro ◽  
Laura Martinez-Valenzuela ◽  
Irene Agraz ◽  
Xavier Fulladosa ◽  
...  
Keyword(s):  
Tubulointerstitial Nephritis ◽  
Checkpoint Inhibitors ◽  
Laboratory Data ◽  
Specific Treatment ◽  
Latency Period ◽  
Response To Treatment ◽  
Acute Tubulointerstitial Nephritis ◽  
Oncological Treatment ◽  
Culprit Drug

Abstract Background The incidence of acute tubulointerstitial nephritis (ATIN) related to drugs has dramatically increased over recent years. A new subtype of ATIN, apparently different from classical drug-related ATIN, has emerged that has been related to the administration of immune checkpoint inhibitors (ICIs). We investigated these differences between ICI-related ATIN (ICI ATIN) and non-ICI-related ATIN in terms of clinical features, response to treatment with steroids and the evolution of kidney function. Methods A total of 47 patients diagnosed with ATIN from two centres were recruited. Of these, 13 patients presented with ATIN during ICI treatment and 34 were diagnosed with ATIN attributed to other drugs. The main demographic, clinical and analytical variables such as gender, age and current medication were recorded. The type of malignancy, oncological treatment, ICI dose and presence of extrarenal immune-related adverse events were also reviewed. Renal biopsy diagnosis, time to drug withdrawal and ATIN-specific treatment, as well as laboratory data during follow-up, were also studied. Results Patients diagnosed with ICI ATIN presented with lower creatinine (ICI ATIN 3.8 ± 1.03  versus classical ATIN 5.98 ± 4.15 mg/dL, P = 0.007) at diagnosis and higher urinary leucocyte counts (ICI ATIN 263.2 ± 418.04 versus classical ATIN 133.55 ± 284.62, P = 0.048) compared with patients with non-ICI-related ATIN. Time from initiation of the culprit drug to ATIN diagnosis was longer in patients with ICI ATIN than in those with classical ATIN (197.07 ± 184.99 versus 114.4 ± 352.16 days, P = 0.006). In addition, during follow-up, the slope of decreasing creatinine over time was lower for ICI ATIN compared with non-ICI-related ATIN. Conclusions In this study, we analysed differences between ICI ATIN and classical ATIN. We found that patients with ICI ATIN presented with a larger latency period after culprit drug initiation, milder acute kidney injury and slower creatinine amelioration compared with those with classical ATIN. These results may, in part, be ascribed to potential differences in the pathological mechanisms involved in ATIN development, suggesting that ICI and classical ATIN may be different diseases with similar renal histologies.

scholarly journals Acute Tubulointerstitial Nephritis in a Patient on Anti-Programmed Death-Ligand 1 Triggered by COVID-19: A Case Report

2021 ◽  
Vol 8 ◽  
pp. 205435812110147
Author(s):  
Dimitry Buyansky ◽  
Catherine Fallaha ◽  
François Gougeon ◽  
Marie-Noëlle Pépin ◽  
Jean-François Cailhier ◽  
...  
Keyword(s):  
Case Report ◽  
Severe Acute Respiratory Syndrome ◽  
Tubulointerstitial Nephritis ◽  
Checkpoint Inhibitor ◽  
Checkpoint Inhibitors ◽  
High Dose ◽  
Programmed Death Ligand 1 ◽  
Acute Tubulointerstitial Nephritis ◽  
Programmed Death ◽  
Kidney Involvement

Rationale: Immune checkpoint inhibitors are monoclonal antibodies used in the treatment of various types of cancers. The downside of using such molecules is the potential risk of developing immune-related adverse events. Factors that trigger these autoimmune side effects are yet to be elucidated. Although any organ can potentially be affected, kidney involvement is usually rare. In this case report, we describe the first known instance of a patient being treated with an inhibitor of programmed death-ligand 1 (anti-PD-L1, a checkpoint inhibitor) who develops acute tubulointerstitial nephritis after contracting the severe acute respiratory syndrome coronavirus 2. Presenting concerns of the patient: A 62-year-old patient, on immunotherapy treatment for stage 4 squamous cell carcinoma, presents to the emergency department with symptoms of lower respiratory tract infection. Severe acute kidney injury is discovered with electrolyte imbalances requiring urgent dialysis initiation. Further testing reveals that the patient has contracted the severe acute respiratory syndrome coronavirus 2. Diagnosis: A kidney biopsy was performed and was compatible with acute tubulointerstitial nephritis. Interventions: The patient was treated with high dose corticosteroid therapy followed by progressive tapering. Outcomes: Rapid and sustained normalization of kidney function was achieved after completion of the steroid course. Novel findings: We hypothesize that the viral infection along with checkpoint inhibitor use has created a proinflammatory environment which led to a loss of self-tolerance to renal parenchyma. Viruses may play a more important role in the pathogenesis of autoimmunity in this patient population than was previously thought.

scholarly journals The effect of lumbosacral manipulation on growing pains

2015 ◽  
Vol 20 (1) ◽  
Author(s):  
Dawid De Beer ◽  
Charmaine M. Bester
Keyword(s):  
Tibialis Anterior Muscle ◽  
Specific Treatment ◽  
Conclusive Evidence ◽  
Self Report ◽  
Response To Treatment ◽  
Rank Test ◽  
Positive Effects ◽  
Pressure Algometer ◽  
Growing Pains

Background: Growing pains are a frequent clinical presentation that continues to puzzle practitioners, with very little conclusive evidence in any medical field, including chiropractic.Objective: The aim of this study was to determine whether lumbosacral manipulations have an effect on growing pain symptoms.Methods: Thirty participants with growing pains between the ages of 4 and 12 years were recruited. The participants were placed into two groups of 15 participants each. Group 1 received lumbosacral manipulations to restricted joints as determined by motion palpation, while Group 2 never received any professional intervention. Often parent(s)/guardian(s) of children who suffer from growing pains will rub the child's legs and offer verbal reassurance in an attempt to console their children. Parent(s)/guardian(s) of both groups were encouraged to continue to do this throughout the duration of the trial. Instructions were given to the parents so that the same rubbing technique and rubbing cream (aqueous cream) were used. Subjective changes were tracked using a pain diary that the parent(s)/guardian(s) were asked to complete, a six-week post-study follow-up question regarding children's growing pains and the Oucher self-report pain scale. Objective measures consisted of pressure algometer readings of the tibialis anterior muscle belly.Results: The statistical data was analysed using the Friedman test, Manne—Whitney test and the Wilcoxon Signed-Rank test. The results demonstrated that both groups responded favourably to their specific treatment over time. However, the group that received lumbosacral manipulations proved to show a quicker response to treatment; and the post study follow-up of this same group showed markedly more positive feedback than the group that did not receive the treatment. These results highlighted the positive effects of chiropractic manipulation on growing pain symptoms.Conclusion: The results from this study, specifically the feedback from parent(s)/guardians(s) and the pain diaries, indicated that spinal manipulation is beneficial in the treatment of growing pains. The results also showed that other methods of treating growing pains, such as simple leg rubs, may also bring relief.

scholarly journals Management of Thyrotoxicosis Induced by PD1 or PD-L1 Blockade

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A841-A841
Author(s):  
Alessandro Brancatella ◽  
Isabella Lupi ◽  
Lucia Montanelli ◽  
Debora Ricci ◽  
Nicola Viola ◽  
...  
Keyword(s):  
Thyroid Function ◽  
Checkpoint Inhibitors ◽  
Thyroid Volume ◽  
Clinical Severity ◽  
Response To Treatment ◽  
Thyroid Function Tests ◽  
Thyroid Ultrasound ◽  
Normal Thyroid ◽  
Normal Thyroid Function

Abstract Context: Thyrotoxicosis is a common immune-related adverse event in patients treated with PD1 or PD-L1 checkpoint inhibitors. A detailed endocrinological assessment, including thyroid ultrasound and scintigraphy is missing, as are data on response to treatment and follow-up. Objectives: To better characterize the thyrotoxicosis secondary to immune checkpoint inhibitors, gaining insights into pathogenesis and informing management. Methods: We conducted a prospective cohort study of 20 consecutive patients who had normal thyroid function before starting immunotherapy and then experienced thyrotoxicosis upon PD1 or PD-L1 blockade. Clinical assessment was combined with thyroid ultrasound, scintigraphy, and longitudinal thyroid function tests. Results: Five patients had normal scintigraphic uptake (Sci+), no serum antibodies against the TSH receptor, and remained hyperthyroid throughout follow-up. The other 15 patients had no scintigraphic uptake (Sci-) and experienced destructive thyrotoxicosis followed by hypothyroidism (N= 9) or euthyroidism (N= 6). Hypothyroidism was more readily seen in those with normal thyroid volume than in those with goiter (P= 0.04). Among Sci- subjects, a larger thyroid volume was associated to a longer time to remission (P<0.05). Methimazole (MMI) was effective only in Sci+ subjects (P<0.05). Conclusions: Administration of PD1 or PD-L1 blocking antibodies may induce two different forms of thyrotoxicosis that appear similar in clinical severity at onset: a type 1 characterized by persistent hyperthyroidism that requires treatment with MMI, and a type 2 characterized by destructive and transient thyrotoxicosis that evolves to hypo- or eu-thyroidism. Thyroid scintigraphy and ultrasound help differentiating and managing these two forms of iatrogenic thyrotoxicosis

scholarly journals Management of thyrotoxicosis induced by PD1 or PD-L1 blockade

2021 ◽  
Author(s):  
Alessandro Brancatella ◽  
Isabella Lupi ◽  
Lucia Montanelli ◽  
Debora Ricci ◽  
Nicola Viola ◽  
...  
Keyword(s):  
Thyroid Function ◽  
Checkpoint Inhibitors ◽  
Thyroid Volume ◽  
Clinical Severity ◽  
Response To Treatment ◽  
Thyroid Function Tests ◽  
Thyroid Ultrasound ◽  
Normal Thyroid ◽  
Normal Thyroid Function

Abstract Background Thyrotoxicosis is a common immune-related adverse event in patients treated with PD1 or PD-L1 blockade. A detailed endocrinological assessment, including thyroid ultrasound and scintigraphy is lacking, as are data on response to treatment and follow-up. Aim of this study was to better characterize the thyrotoxicosis secondary to immune checkpoint inhibitors, gaining insights into pathogenesis and treatment. Methods We conducted a retrospective study of 20 consecutive patients who had normal thyroid function before starting immunotherapy and then experienced thyrotoxicosis upon PD1 or PD-L1 blockade. Clinical assessment was combined with thyroid ultrasound, 99mTechnecium scintiscan and longitudinal thyroid function tests. Results Five patients had normal scintigraphic uptake (Sci+), no serum antibodies against the TSH receptor and remained hyperthyroid throughout follow-up. The other 15 patients had no scintigraphic uptake (Sci-) and experienced destructive thyrotoxicosis followed by hypothyroidism (N= 9) or euthyroidism (N= 6). Hypothyroidism was more readily seen in those with normal thyroid volume than in those with goiter (P= 0.04). Among Sci- subjects, a larger thyroid volume was associated to a longer time to remission (P<0.05). Methimazole (MMI) was effective only in Sci+ subjects (P<0.05). Conclusion Administration of PD1 or PD-L1 blocking antibodies may induce two different forms of thyrotoxicosis that appear similar in clinical severity at onset: a type 1 characterized by persistent hyperthyroidism that requires treatment with MMI and a type 2 characterized by destructive and transient thyrotoxicosis that evolves to hypo- or euthyroidism. Thyroid scintigraphy and ultrasound help differentiating and managing these two forms of iatrogenic thyrotoxicosis.

scholarly journals Acute tubulointerstitial nephritis and polyclonal hypergammaglobulinaemia: Which is the culprit?

2018 ◽  
Vol 8 (4) ◽  
Author(s):  
Ana E. Sirvent ◽  
Ricardo Enríquez ◽  
Tania Muci ◽  
Francisco Javier Ardoy-Ibañez ◽  
Isabel Millán ◽  
...  
Keyword(s):  
Renal Failure ◽  
Renal Function ◽  
Serum Creatinine ◽  
Renal Biopsy ◽  
Proton Pump ◽  
Tubulointerstitial Nephritis ◽  
Systemic Disease ◽  
Acute Tubulointerstitial Nephritis ◽  
Long Period

Proton pump inhibitors (PPIs) are among the most frequent implicated drugs in acute tubulointerstitial nephritis (ATIN), nevertheless it is important to report cases with atypical profiles. A 80-year-old female, exposed during 34 months to omeprazole, presented with polyclonal hypergammaglobulinaemia and renal failure. After stopping omeprazole there was a partial improvement in serum creatinine and IgG. Renal biopsy revealed ATIN; immunohistochemistry for IgG4 was negative. Treatment with steroids and mycophenolate sodium improved renal function and normalized immunoglobulins. The lack of data of other entities and the patient’s evolution strongly point omeprazole as the culprit. After 27 months of follow-up, she remains clinical and analytically stable. ATIN caused by PPIs may appear after a long period of exposure and may be accompanied by analytical anomalies that simulate a systemic disease.

scholarly journals Hematuria Is Associated with More Severe Acute Tubulointerstitial Nephritis

2020 ◽  
Vol 9 (7) ◽  
pp. 2135
Author(s):  
Raquel Esteras ◽  
Jonathan G. Fox ◽  
Colin C. Geddes ◽  
Bruce Mackinnon ◽  
Alberto Ortiz ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Tubulointerstitial Nephritis ◽  
Kidney Injury ◽  
Common Cause ◽  
Acute Tubulointerstitial Nephritis ◽  
Acute Dialysis

Acute tubulointerstitial nephritis (ATIN) is a common cause of acute kidney injury. Although haematuria is a risk factor for the development of renal disease, no previous study has analyzed the significance of haematuria in ATIN. Retrospective, observational analysis of 110 patients with biopsy-proven ATIN was conducted. Results: Haematuria was present in 66 (60%) ATIN patients. A higher percentage of ATIN patients with haematuria had proteinuria than patients without haematuria (89.4% vs. 59.1%, p = 0.001) with significantly higher levels of proteinuria (median (interquartile range) protein:creatinine ratio 902.70 (513–1492) vs. 341.00 (177–734) mg/g, p <0.001). Moreover, those patients with more haematuria intensity had a higher urinary protein:creatinine ratio (1352.65 (665–2292) vs. 849.60 (562–1155) mg/g, p = 0.02). Those patients with higher proteinuria were more likely to need renal replacement therapy (22.7 vs. 0%, p = 0.03) and to suffer relapse (4 vs. 0%, p = 0.03). At the end of follow up, haematuric ATIN patients had higher serum creatinine levels (3.19 ± 2.91 vs. 1.91 ± 1.17 mg/dL, p = 0.007), and a trend towards a higher need for acute dialysis (7 vs. 1%, p = 0.09) and renal replacement therapy (12.1 vs. 2.3%, p = 0.12). Haematuria is common in ATIN and it is associated with worse renal function outcomes.

Changes in lymphocyte/monocyte ratio, prognostic marker to predict overall survival in patients with advanced cancer treated with immune checkpoint inhibitor.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 3047-3047
Author(s):  
Sandip H. Patel ◽  
Mingjia Li ◽  
Songzhu Zhao ◽  
Lai Wei ◽  
Jarred Thomas Burkart ◽  
...  
Keyword(s):  
Overall Survival ◽  
Tumor Microenvironment ◽  
Advanced Cancer ◽  
Immune Checkpoint ◽  
Peripheral Blood ◽  
Checkpoint Inhibitors ◽  
Response To Treatment ◽  
Rank Test ◽  
Comparison Results

3047 Background: Immunosuppressive factors within the tumor microenvironment (TME) pose a barrier to response to treatment with immune checkpoint inhibitors (ICI). Monocytes alter the TME to promote cancer progression through local immune suppression and angiogenesis. Peripheral blood lymphocyte-to-monocyte ratio (LMR) may reflect the interaction between host immunity, represented by lymphocytes, and the tumor microenvironment, represented by monocytes. A low LMR in the peripheral blood may serve as a surrogate biomarker and has been associated with poor prognosis in various cancers; however, its role has not been well defined in the era of treatment with ICI. Methods: We retrospectively evaluated 1034 patients with advanced cancer treated with ICI from 2011 to 2017. We calculated LMR as ratio of absolute lymphocyte/monocyte counts at baseline and median of 21 days after first cycle of ICI (on-treatment LMR) and considered low if < 2. Overall survival (OS) was calculated from the initiation of ICI to date of death or censored at last follow-up. Median OS with 95% confidence intervals (CI) was estimated using the Kaplan-Meier method. Log rank test was used for group comparison. Results: 536 pts (52%) with LMR < 2 at baseline had shorted median OS compared to 498 (48%) with LMR≥2 (median OS 8.4 months vs 17.8 months, p < 0.001). Of 1034 pts with baseline LMR, 837 had follow up LMR evaluable. In patients with baseline and on-treatment LMR, those with baseline LMR < 2, who had on treatment LMR ≥2, had OS of 16.8 months (95% CI 10.3-23.5) compared to median OS 8.0 months (95% CI 6-9.4) for patients with on treatment LMR < 2 after first cycle of ICI, p < 0.001. Patients with baseline LMR≥2, who had on treatment LMR ≥ 2, had median OS of 23 months (95% CI 19.7-28.9), but median OS was 9.4 months (95% CI 7.1-11.1) for patients with on-treatment LMR < 2 after first cycle of ICI, p < 0.001. Conclusions: We observed a statistically significant association between not only baseline LMR but also change in LMR from baseline after first cycle of ICI and overall survival in cancer patients treated with ICI. The role of LMR at baseline and on-treatment LMR should be evaluated in further studies incorporating known additional prognostic factors for ICI therapy. [Table: see text]

scholarly journals P139 Significant Changes In Routine Biochemical Markers Occur Up To 5 Years Prior To Inflammatory Bowel Disease Diagnosis: A Case-Control Study

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S225-S226
Author(s):  
N A Cohen ◽  
E Kliper ◽  
N Zamstein ◽  
T Ziv-Baran ◽  
A Ben Tov ◽  
...  
Keyword(s):  
Laboratory Data ◽  
Disease Diagnosis ◽  
Response To Treatment ◽  
White Blood Count ◽  
Distribution Data ◽  
Indeterminate Colitis ◽  
Mean Values ◽  
Laboratory Results ◽  
Inflammatory Bowel

Abstract Background Early diagnosis of inflammatory bowel diseases (IBD) is associated with improved response to treatment and disease outcomes. Predicting patients at risk of developing symptomatic IBD would provide a window of opportunity to treat patients before irreversible bowel damage is caused. Our aim is to determine whether there is a pattern of change in use of health resources, medications and laboratory results in the years prior to diagnosis. Methods This is a retrospective study performed using electronic medical records (EMR) of Maccabi Health Services (MHS) which insures 25% of the Israeli population with a nationwide distribution. Data was extracted using MDClone (MDClone Ltd). IBD patients ≥ 16 years of age and minimum of 5 years follow up were identified by entry into the MHS IBD registry and included in the study. Demographic, clinical, medication and laboratory data was collected. Generalized estimating equation (GEE) model was applied to study trends and compare between years. Results A total of 5643 IBD patients were included. Of these, 3039 (53.8%) had Crohn’s disease (CD), 2322 (41.1%) had ulcerative colitis (UC) and 282 (5%) had indeterminate colitis (IC). The mean age of the total IBD population at inclusion to the registry was 39.3 ± 16.5 years. Overall, CD patients had significantly increased visits to general practitioners, emergency rooms and admissions compared to UC patients (33.2 vs 30, p&lt;0.0001; 0.2 vs 0.17, p&lt;0.0001 and 0.88 vs 0.71, p&lt;0.0001, respectively). CD and IC patients had similar patterns of medical professional/institution visits. Laboratory parameters such as haemoglobin and mean corpuscular volume showed significant decrease and white blood count, platelets and c-reactive protein showed significant increase in mean values primarily in the 2 years prior to diagnosis with stable values prior to that (p&lt;0.0001 for all parameters). In contrast, parameters such as creatinine, total protein, albumin and calcium showed earlier significant and progressive decreases in mean values starting 5 years prior to diagnosis (p&lt;0.0001 for all parameters) (Figure 1). Use of medications such as nonsteroidal anti-inflammatory drugs, etanercept, steroids, proton pump inhibitors and antibiotics significantly increased in the 2 years prior to IBD registry entry (P&lt;0.0001 for all). Conclusion There are clear changes from baseline in uptake of medical resources, medication usage and laboratory results in the 5 years prior to IBD diagnosis. Parameters such as creatinine and albumin give earlier signal than others. This data may allow the development of an algorithm stratifying patients into those who need more intensive follow-up or investigations to enable earlier disease diagnosis.

scholarly journals MO160COVID-19 INFECTION AND ACUTE TUBULOINTERSTITIAL NEPHRITIS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Juan Carlos León ◽  
Irene Agraz ◽  
Ander Vergara Arana ◽  
Natalia Ramos Terrada ◽  
Clara García Carro ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Kidney Function ◽  
Nosocomial Pneumonia ◽  
Tubulointerstitial Nephritis ◽  
Kidney Injury ◽  
Acute Tubulointerstitial Nephritis ◽  
History Of

Abstract Background COVID-19 infection manifests as pneumonia associated with multiple organ failure, and death. Acute kidney injury is a risk factor for mortality. There is limited scientific literature on COVID-19 infection and allergic tubulointerstitial nephritis, its clinical course and short- and long-term prognosis. Method We performed a retrospective study where medical records of 60 patients with histological diagnosis of allergic tubulointerstitial nephritis from January 2009 to November 2020. In these patients, we studied the incidence of COVID-19 infection, clinical characteristics and prognosis from March to the actual date. Results Of 60 patients with allergic tubulointerstitial nephritis, 6 (10%) patients were diagnosed with COVID-19. The first case, an 85-year-old woman with a history of metastatic melanoma treated with nivolumab and allergic tubulointerstitial nephritis by immunobiological agents in 2018, diagnosed with mild COVID-19 infection in April 2020 without deterioration of renal function in controls at 3 and 6 months of follow-up. The second case, a 51-year-old woman with a history of large B-cell lymphoma with plasmacytic differentiation and progression to multiple myeloma of lambda light chains and allergic tubulointerstitial nephritis due to chemotherapy since 2019, admitted for acute pyelonephritis and PRES syndrome secondary to first dose of bortezomib complicated with COVID-19 nosocomial pneumonia and acute pancreatitis treated with corticosteroids and broad spectrum antibiotic therapy; she died of abdominal refractory septic shock. The third patient, a 64-year-old man without prior renal impairment, was admitted for severe COVID-19 pneumonia and acute kidney injury secondary to acute tubulointerstitial nephritis of uncertain etiology that required orotracheal intubation and continuous veno-venous hemodiafiltration for a week who received methylprednisolone in bolus for 3 days and continued treatment with corticosteroid therapy with complete recovery of renal function and improvement in proteinuria at 3 months of follow-up. The fourth patient, an 82-year-old woman with acute kidney injury AKIN 3 secondary to acute allergic tubulointerstitial nephritis related to ciprofloxacin complicated with severe COVID-19 nosocomial pneumonia, who died despite ventilatory support and high-dose steroids therapy and tocilizumab. The fifth patient, a 75-year-old with a history of metastatic lung adenocarcinoma treated with immunobiological agents and allergic tubulointerstitial nephritis in  2018, admitted in march 2020 for mild COVID-19 pneumonia treated with steroids and hydroxychloroquine without deterioration of respiratory and kidney function.  The sixth patient, an 86-years-old man with acute kidney injury AKIN 3 due to acute allergic tubulointerstitial nephritis secondary to proton-binding inhibitors and nosocomial COVID-19 infección with improvement of kidney function with steroids therapy only.  Conclusion Our 6 patients with allergic tubulointerstitial nephritis and COVID-19 infection presented different spectrum of the disease. It seems that nosocomial COVID-19 infection in patients admitted with recent diagnosis of acute allergic tubulointerstitial nephritis presented a worse clinical prognosis compared with long-term diagnosed acute tubulointerstitial nephritis. Further studies with a larger sample size are needed.

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