scholarly journals Duration of Treatment with Corticosteroids and Recovery of Kidney Function in Acute Interstitial Nephritis

2018 ◽  
Vol 13 (12) ◽  
pp. 1851-1858 ◽  
Author(s):  
Gema Fernandez-Juarez ◽  
Javier Villacorta Perez ◽  
Fernando Caravaca-Fontán ◽  
Luis Quintana ◽  
Amir Shabaka ◽  
...  
Keyword(s):  
Kidney Function ◽  
Interstitial Nephritis ◽  
Corticosteroid Treatment ◽  
Acute Interstitial Nephritis ◽  
High Dose ◽  
Duration Of Treatment ◽  
Drug Induced ◽  
High Dose Corticosteroid ◽  
Acute Kidney Disease ◽  
Dose Corticosteroid

Background and objectivesDrug-induced acute interstitial nephritis represents an emerging cause of acute kidney disease, especially among polymedicated elderly patients. Although corticosteroids are frequently used, controversy exists about the timing of initiation, efficacy, safety, and duration of treatment.Design, setting, participants, & measurementsWe performed a retrospective study of 182 patients with biopsy-proven drug-induced acute interstitial nephritis from 13 Spanish centers. Exposure was defined as the length of corticosteroid treatment. The main outcome was the level of serum creatinine at month 6, with respect to baseline values.ResultsThe most common offending agents were nonsteroidal anti-inflammatory drugs (27%). In 30% of patients, the offending drug could not be identified. The median time to suspected drug withdrawal was 11 days (interquartile range, 5–22). All patients presented with acute kidney disease and were treated with corticosteroids. The mean initial dose of prednisone was 0.8±0.2 mg/kg per day. High-dose corticosteroid treatment was maintained for 2 weeks (interquartile range, 1–4). After 6 months, the mean recovered GFR was 34±26 ml/min per 1.73 m2 and ten patients required maintenance dialysis. Use of high-dose corticosteroids for 3 weeks or treatment duration >8 weeks were not associated with better recovery of kidney function. In the multivariable analysis, delayed onset of steroid treatment (odds ratio, 1.02; 95% confidence interval, 1.0 to 1.04) and the presence of interstitial fibrosis of >50% on the kidney biopsy specimen (odds ratio, 8.7; 95% confidence interval, 2.7 to 27.4) were both associated with serum creatinine level at month 6 of >75%, with respect to baseline values.ConclusionsHigh-dose corticosteroid treatment for 3 weeks or prolonged treatment for >8 weeks were not associated with greater kidney function recovery in drug-induced acute interstitial nephritis. A delay in the initiation of corticosteroids resulted in worse recovery of kidney function.

scholarly journals The Controversy About the Effects of Different Doses of Corticosteroid Treatment on Clinical Outcomes for Acute Respiratory Distress Syndrome Patients: An Observational Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Jia-Wei Yang ◽  
Ping Jiang ◽  
Wen-Wen Wang ◽  
Zong-Mei Wen ◽  
Bei Mao ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Systemic Corticosteroid ◽  
Corticosteroid Treatment ◽  
Apache Ii Score ◽  
High Dose ◽  
High Dose Corticosteroid ◽  
Dose Corticosteroid

Background: Corticosteroid usage in acute respiratory distress syndrome (ARDS) remains controversial. We aim to explore the correlation between the different doses of corticosteroid administration and the prognosis of ARDS.Methods: All patients were diagnosed with ARDS on initial hospital admission and received systemic corticosteroid treatment for ARDS. The main outcomes were the effects of corticosteroid treatment on clinical parameters and the mortality of ARDS patients. Secondary outcomes were factors associated with the mortality of ARDS patients.Results: 105 ARDS patients were included in this study. Corticosteroid treatment markedly decreased serum interleukin-18 (IL-18) level (424.0 ± 32.19 vs. 290.2 ± 17.14; p = 0.0003) and improved arterial partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) (174.10 ± 65.28 vs. 255.42 ± 92.49; p < 0.0001). The acute physiology and chronic health evaluation (APACHE II) score (16.15 ± 4.41 vs. 14.88 ± 4.57, p = 0.042) decreased significantly on the seventh day after systemic corticosteroid treatment. Interestingly, the serum IL-18 decreased significantly (304.52 ± 286.00 vs. 85.85 ± 97.22, p < 0.0001), whereas the improvement of PaO2/FiO2 (24.78 ± 35.03 vs. 97.17 ± 44.82, p < 0.001) was inconspicuous after systemic corticosteroid treatment for non-survival patients, compared with survival patients. Furthermore, the receiver operating characteristic (ROC) model revealed, when equivalent methylprednisolone usage was 146.5 mg/d, it had the best sensitivity and specificity to predict the death of ARDS. Survival analysis by Kaplan–Meier curves presented the higher 45-day mortality in high-dose corticosteroid treatment group (logrank test p < 0.0001). Multivariate Cox regression analyses demonstrated that serum IL-18 level, APACHE II score, D-dimer, and high-dose corticosteroid treatment were associated with the death of ARDS.Conclusion: Appropriate dose of corticosteroids may be beneficial for ARDS patients through improving the oxygenation and moderately inhibiting inflammatory response. The benefits and risks should be carefully weighed when using high-dose corticosteroid for ARDS.Trial registration: This work was registered in ClinicalTrials.gov. Name of the registry: Corticosteroid Treatment for Acute Respiratory Distress Syndrome. Trial registration number: NCT02819453. URL of trial registry record: https://register.clinicaltrials.gov.

Sleep-EEG effects of high-dose corticosteroid treatment in multiple sclerosis

2005 ◽  
Vol 38 (05) ◽  
Author(s):  
MC Rosenhagen ◽  
P Schüssler ◽  
U Schmidt ◽  
A Yassouridis ◽  
A Steiger
Keyword(s):  
Multiple Sclerosis ◽  
Corticosteroid Treatment ◽  
Sleep Eeg ◽  
High Dose ◽  
High Dose Corticosteroid ◽  
Dose Corticosteroid

High-dose corticosteroid treatment of immunotherapy-induced hypophysitis: A multi-centric, restrospective analysis

2020 ◽  
Author(s):  
Felix Amereller ◽  
Mamta Joshi ◽  
Timo DEUTSCHBEIN ◽  
Leo Duffy ◽  
Paul Carroll ◽  
...  
Keyword(s):  
Corticosteroid Treatment ◽  
High Dose ◽  
High Dose Corticosteroid ◽  
Dose Corticosteroid

Pseudotumor cerebri following tapered corticosteroid treatment in an 8-month-old infant

2008 ◽  
Vol 1 (1) ◽  
pp. 88-90 ◽  
Author(s):  
Wilson Z. Ray ◽  
Amy Lee ◽  
Spiros L. Blackburn ◽  
Gregg T. Lueder ◽  
Jeffrey R. Leonard
Keyword(s):  
Lumbar Puncture ◽  
High Volume ◽  
Corticosteroid Treatment ◽  
Pseudotumor Cerebri ◽  
Capillary Hemangioma ◽  
High Dose ◽  
Ophthalmological Examination ◽  
High Dose Corticosteroid ◽  
Dose Corticosteroid

✓The authors report on an 8-month-old infant with an orbital capillary hemangioma. The patient had been treated with high-dose corticosteroid therapy and had had a recent decrease in dose. The patient presented to the emergency department with increased irritability and bulging fontanelles. On lumbar puncture the opening pressure was > 55 cm H2O. Ophthalmological examination revealed interval development of papilledema. The child was treated with high-volume lumbar puncture, subsequent drainage of 10 ml of cerebrospinal fluid, resumption of the previous steroid dose, and acetazolomide therapy. The patient's symptoms resolved and follow-up ophthalmological examination revealed interval resolution of papilledema. The authors present the youngest reported case of pseudotumor development after corticosteroid tapering.

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