Hypersensitivity Nephropathy Treatment & Management

Updated: Sep 17, 2019
  • Author: Micah L Thorp, DO, MPH; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Treatment

Medical Care

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

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).

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 by randomized controlled trials. 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. The study further found that delays in treatment led to decreased function. [14]

Occasionally, AIN patients who had shown a positive response to corticosteroids, present a relapse coinciding with treatment discontinuation.Cortico-dependant, relapsing AIN poses an important therapeutic challenge [2]

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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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