Medical Care

Most cases of acute interstitial nephritis (AIN) are diagnosed in the hospital setting. Carefully monitor kidney function until the AIN has resolved.

The most important aspect of treatment is removal of the offending agents. Occasionally, more than one agent may be causing AIN. Consider the likelihood of each potential agent and substitute for each of the most likely agents, if possible.

If removing the inciting agents or treating the underlying infection does not improve kidney function, consider corticosteroid therapy. Although corticosteroids are widely used in drug-induced AIN to speed kidney function recovery and avoid chronic kidney disease, their efficacy has not been tested in randomized controlled trials. In a retrospective study of 61 patients with biopsy-proven AIN, 52 of whom were treated with corticosteroids, more than half of those treated showed complete recovery of baseline kidney function. The study further found that complete recovery occurred less often in patients whose steroid treatment was delayed than in those who were started on steroid therapy within 2 weeks of withdrawal of the offending drugs.^[20]

Occasionally, AIN patients who have shown a positive response to corticosteroids experience a relapse when treatment is discontinued. Corticosteroid-dependent relapsing AIN poses an important therapeutic challenge.^[3] In a case of corticosteroid-dependent AIN, the addition of mycophenolate mofetil (MMF) allowed for a significant reduction in corticosteroid dosage from 60 mg/d to 5 mg/d.^[21]

Consultations

Consider consultation with a nephrologist in all patients thought to have acute interstitial nephritis. This is particularly important for patients whose kidney 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.

Medication

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