Dirim Ahmet Burak, Namazova Nazrin, Dirim Merve Guzel, Oto Ozgur Akin, Artan Ayse Serra, Hurdogan Ozge, Ozluk Yasemin, Yazici Halil
Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Istanbul University, 34104, Istanbul, Turkey.
Department of Internal Medicine, Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Wien Klin Wochenschr. 2025 Jan;137(1-2):31-40. doi: 10.1007/s00508-024-02417-2. Epub 2024 Aug 27.
Acute tubulointerstitial nephritis (AIN) is an immune-mediated disorder that can cause acute kidney injury (AKI). We aimed to investigate the characteristics of patients with AIN and predictive factors for treatment response.
In this study, thirty-one patients diagnosed with AIN on kidney biopsy between 2006 and 2021 were included. Baseline clinical, histopathological, and laboratory findings, including complete blood count (CBC), creatinine, erythrocyte sedimentation rate, C‑reactive protein, C3, C4, systemic immune inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and urinalysis were evaluated. Treatment response, mortality, and creatinine levels at the time of last follow-up were also noted.
The median age was 46 years and 80.6% were female. Median baseline creatinine and proteinuria levels were 4.1 mg/dL and 0.84 gram/day. The median follow-up period was 14 months and 93.5% received immunosuppressives. End-stage kidney disease (ESKD) developed in five patients (16.1%). Renal recovery (creatinine < 1.4 mg/dL) was observed in 17 patients (54.8%). Higher degrees of interstitial fibrosis, tubular atrophy, granuloma formation, global glomerulosclerosis, and higher baseline hemoglobin levels, in addition to a longer interval between first symptom to initiation of immunosuppressives were associated with renal nonrecovery, statistically. Also, patients who progressed to ESKD had higher baseline hemoglobin (p = 0.033) and lymphocyte (p = 0.044) and lower PLR levels (p = 0.016), as well as higher degrees of global glomerulosclerosis (p = 0.014), interstitial fibrosis (p = 0.042), and tubular atrophy (p = 0.030).
Treatment response rates are low for AIN, which may lead to ESKD. Besides chronicity in histopathology specimens, higher baseline hemoglobin levels and lower platelet-to-lymphocyte ratio might be prognostic. Further studies should be conducted on new markers for AIN.
急性肾小管间质性肾炎（AIN）是一种免疫介导的疾病，可导致急性肾损伤（AKI）。我们旨在研究AIN患者的特征及治疗反应的预测因素。
本研究纳入了2006年至2021年间经肾活检诊断为AIN的31例患者。评估了基线临床、组织病理学和实验室检查结果，包括全血细胞计数（CBC）、肌酐、红细胞沉降率、C反应蛋白、C3、C4、全身免疫炎症指数（SII）、中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）以及尿液分析。还记录了治疗反应、死亡率和最后一次随访时的肌酐水平。
中位年龄为46岁，80.6%为女性。基线肌酐和蛋白尿水平中位数分别为4.1mg/dL和0.84克/天。中位随访期为14个月，93.5%的患者接受了免疫抑制剂治疗。5例患者（16.1%）发展为终末期肾病（ESKD）。17例患者（54.8%）观察到肾脏恢复（肌酐<1.4mg/dL）。组织学上更高程度的间质纤维化、肾小管萎缩、肉芽肿形成、全球肾小球硬化，以及更高的基线血红蛋白水平，此外，从首次症状出现到开始使用免疫抑制剂的间隔时间更长，在统计学上与肾脏未恢复相关。此外，进展为ESKD的患者基线血红蛋白（p = 0.033）和淋巴细胞水平更高（p = 0.044），PLR水平更低（p = 0.016），以及全球肾小球硬化（p = 0.014）、间质纤维化（p = 0.042）和肾小管萎缩程度更高（p = 0.030）。
AIN的治疗反应率较低，可能导致ESKD。除了组织病理学标本中的慢性病变外，更高的基线血红蛋白水平和更低的血小板与淋巴细胞比值可能具有预后意义。应针对AIN的新标志物开展进一步研究。
