Early steroid treatment improves the recovery of renal function in patients with drug-induced acute interstitial nephritis
Early steroid treatment improves the recovery of renal function in patients with drug-induced acute interstitial nephritis
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DOI：
10.1038/sj.ki.5002776
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发表时间：
2008-04-01
影响因子：
19.6
通讯作者：
Praga, M.
中科院分区：
文献类型：
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作者：
Gonzalez, E.;Gutierrez, E.;Praga, M.
类固醇治疗在药物诱导的急性间质性肾炎(DI-AIN)中的作用存在争议。我们进行了一项多中心的回顾性研究，以确定激素对61例活检证实的DI-AIN患者的影响，其中52人接受了类固醇治疗。主要用药为抗生素类(56%)、非类固醇类抗炎药(37%)或其他药物。接受治疗的患者最终血肌酐显著降低，而几乎一半的未接受治疗的患者仍在接受慢性透析。在接受治疗的患者中，超过一半的患者显示基础肾功能完全恢复，而其余的患者仍处于肾功能衰竭状态。在激素持续时间或剂量方面，这两个亚组之间的初始差异并不显著。停用假定致病药物后，我们发现当激素治疗延迟(平均34天)时，与停用致病药物后2周内接受激素治疗的患者相比，肾功能没有恢复到基线水平。我们发现激素治疗的延迟与最终的血肌酐之间存在显著的相关性。肾活检，包括三名接受第二次活检的患者，显示间质纤维化的进展与类固醇治疗的延迟有关。我们的研究表明，在诊断出DI-AIN后，应立即开始使用类固醇，以避免随后的间质纤维化和肾功能的不完全恢复。
The role of steroid treatment in drug-induced acute interstitial nephritis (DI-AIN) is controversial. We performed a multicenter retrospective study to determine the influence of steroids in 61 patients with biopsy-proven DI-AIN, 52 of whom were treated with steroids. The responsible drugs were antibiotics (56%), non-steroidal anti-inflammatory drugs (37%) or other drugs. The final serum creatinine was significantly lower in treated patients while almost half of untreated patients remained on chronic dialysis. Among treated patients, over half showed a complete recovery of baseline renal function, whereas the rest remained in renal failure. There were no significant initial differences between these two subgroups in terms of duration or dosage of steroids. After withdrawal of the presumed causative drug, we found that when steroid treatment was delayed (by an average of 34 days) renal function did not return to baseline levels compared to those who received steroid treatment within the first 2 weeks after withdrawal of the offending agent. We found a significant correlation between the delay in steroid treatment and the final serum creatinine. Renal biopsies, including three patients who underwent a second biopsy, showed a progression of interstitial fibrosis related to the delay in steroid treatment. Our study shows that steroids should be started promptly after diagnosis of DI-AIN to avoid subsequent interstitial fibrosis and an incomplete recovery of renal function.