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. 2020 Mar 11;14(1):197-204.
doi: 10.1093/ckj/sfaa018. eCollection 2021 Jan.

Recurrent acute interstitial nephritis: what lies beneath

Fernando Caravaca-Fontán  1   2 , Amir Shabaka  3 , Beatriz Sánchez-Álamo  3 , Alberto de Lorenzo  4 , Martha Díaz  5 , Miquel Blasco  6 , Eva Rodríguez  7 , Milagros Sierra-Carpio  8 , Tamara Malek Marín  9 , Andrés Urrestarazú  10 , Clara Corona Cases  3 , Manuel Praga  1   2 , Gema Fernández-Juárez  3 ; Spanish Group for the Study of Glomerular Diseases (GLOSEN)
Affiliations

Recurrent acute interstitial nephritis: what lies beneath

Fernando Caravaca-Fontán et al. Clin Kidney J. .

Abstract

Background: Acute interstitial nephritis (AIN) is an emerging cause of acute kidney disease. While this disease usually follows an acute course, it may occasionally recur, representing a major challenge for the clinician.

Methods: We performed a retrospective, observational cohort study in 13 nephrology departments belonging to the Spanish Group for the Study of Glomerular Diseases. Patients with biopsy-proven AIN between 1996 and 2018 were included.

Results: The study group consisted of 205 patients with AIN, 22 of which developed recurrent AIN (RAIN) after a median of 111 days from diagnosis. RAIN was due to a surreptitious reintroduction of a previously known implicated drug or toxic in six patients (27%), sarcoidosis in two (9%), Sjögren's syndrome in three (14%), light-chain-mediated AIN in two (9%) and tubulointerstitial nephritis and uveitis syndrome in two (9%), while in the rest of cases (32%), no precise cause could be identified. Microscopic haematuria was more frequent in patients with underlying systemic diseases. The first RAIN episode was treated with a repeated course of corticosteroids in 21 patients (95%). In six cases (27%), azathioprine and mycophenolate mofetil were added as corticosteroid-sparing agents. During a median follow-up of 30 months, 50 patients (27%) with no recurrences and 12 patients (55%) with RAIN reached Stages 4 and 5 chronic kidney disease (CKD). By multivariable logistic regression analysis, RAIN was independently associated with the risk of reaching Stages 4 and 5 CKD, even after adjusting for potential covariables.

Conclusions: RAIN is infrequent but is associated with poor kidney survival. RAIN should prompt clinicians to search for an underlying aetiology other than drug induced. However, in a large percentage of cases, no precise cause can be identified.

Keywords: acute interstitial nephritis; chronic kidney disease; recurrent acute interstitial nephritis.

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Figures

FIGURE 1
FIGURE 1
Kaplan–Meier renal survival curves according to recurrence of AIN.
See this image and copyright information in PMC

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