Hypersensitivity Nephropathy Treatment & Management

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

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.

Corticosteroids

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

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.

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Consultations

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.

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