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Hypersensitivity Nephropathy Treatment & Management

  • Author: Micah L Thorp, DO, MPH; Chief Editor: Vecihi Batuman, MD, FACP, FASN  more...
Updated: Dec 01, 2015

Medical Care

Offending agents

The most important aspect of treatment is removal of the offending agents.

Occasionally, more than one agent may be causing acute interstitial nephritis (AIN). Consider the likelihood of each potential agent and substitute for each of the most likely agents (if possible).

After removing the inciting agents, administer prednisone.


If removing the inciting agents or treating the underlying infection does not improve renal function, consider corticosteroid therapy.

A retrospective study of 61 patients with biopsy-proven acute interstitial nephritis found 52 treated with corticosteroids, one half of whom showed a significant clinical improvement.[7] The study further found that delays in treatment led to decreased function.[7]


Cyclophosphamide therapy is controversial. This treatment causes significant short-term adverse effects in many patients, which makes many clinicians reluctant to use it in primary therapy.

Cyclophosphamide has been studied in experimental animal models of acute interstitial nephritis.



Consider consultation with a nephrologist in all patients thought to have acute interstitial nephritis. This is particularly important among patients whose renal function does not improve following the removal of suspected medications. Because prognosis is tied to the length of time a patient has acute interstitial nephritis, consider consultation early in the course of illness.

Contributor Information and Disclosures

Micah L Thorp, DO, MPH Consulting Staff, Department of Nephrology, Lake Road Nephrology Center, Northwest Permanente Medical Group

Micah L Thorp, DO, MPH is a member of the following medical societies: American College of Physicians, American Society of Nephrology, American Medical Association, National Kidney Foundation

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Ajay K Singh, MB, MRCP, MBA Associate Professor of Medicine, Harvard Medical School; Director of Dialysis, Renal Division, Brigham and Women's Hospital; Director, Brigham/Falkner Dialysis Unit, Faulkner Hospital

Disclosure: Nothing to disclose.

Chief Editor

Vecihi Batuman, MD, FACP, FASN Huberwald Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine; Chief, Renal Section, Southeast Louisiana Veterans Health Care System

Vecihi Batuman, MD, FACP, FASN is a member of the following medical societies: American College of Physicians, American Society of Hypertension, American Society of Nephrology, International Society of Nephrology

Disclosure: Nothing to disclose.

Additional Contributors

Chike Magnus Nzerue, MD, FACP Professor of Medicine, Associate Dean for Clinical Affairs, Meharry Medical College

Chike Magnus Nzerue, MD, FACP is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Society of Nephrology, National Kidney Foundation

Disclosure: Nothing to disclose.

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Acute interstitial nephritis with mononuclear cell infiltrate.
Mononuclear cell infiltrate between tubules.
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