Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN.
Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN.
Am J Kidney Dis. 2014 Oct;64(4):558-66. doi: 10.1053/j.ajkd.2014.04.027. Epub 2014 Jun 11.
Acute interstitial nephritis (AIN) is an important cause of acute kidney injury, especially in hospitalized patients. The cause and outcome of AIN, particularly that due to drugs, is changing with prevalent medication use. The effectiveness of steroids for treatment of AIN is debated.
Case series.
SETTING & PARTICIPANTS: 133 patients with biopsy-proven AIN from 1993 through 2011 at a single center.
Recovery of kidney function by 6 months, either complete, partial, or none. Complete recovery was defined as improvement in serum creatinine level to within 25% of baseline (or < 1.4 mg/dL), and partial recovery, as a ≥ 50% decrease in serum creatinine level from its peak value but not reaching within 25% of its baseline value.
Causes of AIN included drugs (70%), autoimmune diseases (20%), and infections (4%). Drug-induced AIN was due to antibiotics in 49%, proton pump inhibitors (PPIs) in 14%, and nonsteroidal anti-inflammatory drugs (NSAIDs) in 11%. Overall, the top 3 drug causes were omeprazole (12%), amoxicillin (8%), and ciprofloxacin (8%). Patients with drug-induced compared to non-drug-induced AIN were older and had higher baseline kidney function, but more severe acute kidney injury. Patients with PPI-induced AIN were older, were less symptomatic, and had longer durations of drug exposure and longer delays in getting kidney biopsy and steroids than for antibiotic-induced or NSAID-induced AIN. At 6 months postbiopsy, 49% of patients with drug-induced AIN treated with steroids achieved complete recovery; 39%, partial recovery; and 12%, no recovery. Correlates of poor recovery included a longer duration of drug exposure (15 vs 30 vs 130 days for complete, partial, and no recovery, respectively; P = 0.04) and longer delay in starting steroid therapy (8 vs 11 vs 35 days, respectively; P = 0.05).
Retrospective study, selection bias in patients who had kidney biopsy, single-center experience.
The cause of AIN may be shifting; PPIs are emerging as an important contributor to this disease. Delays in discontinuation of the culprit drug and in initiating steroid treatment adversely affect recovery of kidney function.
急性间质性肾炎（AIN）是急性肾损伤的一个重要病因，尤其在住院患者中更为常见。随着常用药物的变化，AIN 的病因和结局，尤其是药物引起的 AIN，也在发生变化。皮质类固醇治疗 AIN 的疗效存在争议。
病例系列研究。
1993 年至 2011 年间，在一家单中心，对 133 例经肾活检证实的 AIN 患者进行了研究。
6 个月时，肾功能恢复情况分为完全恢复、部分恢复和无恢复。完全恢复定义为血清肌酐水平恢复至基础值的 25%以内（或＜1.4mg/dL），部分恢复定义为血清肌酐峰值下降≥50%，但未恢复至基础值的 25%以内。
AIN 的病因包括药物（70%）、自身免疫性疾病（20%）和感染（4%）。药物性 AIN 中，抗生素占 49%，质子泵抑制剂（PPIs）占 14%，非甾体抗炎药（NSAIDs）占 11%。总体而言，引起 AIN 的前 3 种药物是奥美拉唑（12%）、阿莫西林（8%）和环丙沙星（8%）。与非药物性 AIN 相比，药物性 AIN 患者年龄较大，基础肾功能较好，但急性肾损伤更严重。与抗生素或 NSAIDs 引起的 AIN 相比，PPI 引起的 AIN 患者年龄较大，症状较轻，药物暴露时间更长，接受肾活检和皮质类固醇治疗的时间延迟更长。在肾活检后 6 个月时，接受皮质类固醇治疗的药物性 AIN 患者中，49%完全恢复，39%部分恢复，12%无恢复。恢复不良的相关因素包括药物暴露时间更长（分别为完全恢复、部分恢复和无恢复的 15、30 和 130 天；P=0.04）和开始皮质类固醇治疗的时间延迟更长（分别为 8、11 和 35 天；P=0.05）。
回顾性研究，肾活检患者存在选择偏倚，单中心经验。
AIN 的病因可能正在发生变化；PPIs 正成为该病的一个重要病因。停用致病药物和开始皮质类固醇治疗的时间延迟会对肾功能的恢复产生不利影响。
