Successful relatively low-dose corticosteroid therapy for diclofenac-induced acute interstitial nephritis with severe renal failure.
We report a case of nephrotic syndrome and acute renal failure that developed in a 73-year-old woman after six months of treatment with the non-steroidal anti-inflammatory drug (NSAID) diclofenac. Renal biopsy revealed interstitial nephritis and minimal change nephropathy. Despite discontinuation of treatment with diclofenac, she subsequently became anuric and required hemodialysis for progressive azotemia. Since her anuria was persistent, treatment with prednisone at a dose of 30 mg/day was started. With progressive increase in urine output after the initiation of corticosteroid treatment, a constant decrease in serum creatinine was observed along with improvement of creatinine clearance. In addition, the increased urinary excretion of beta2-microglobulin (beta2MG) and N-acetyl-beta-D-glucosaminidase (NAG) on admission was also improved during the treatment. Our findings suggest that corticosteroid treatment should be reserved for patients with the protracted deterioration of renal function even after discontinuation of offending trigger agents.
Inoue
Makoto
M
Department of Internal Medicine, Division of Nephrology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan. mac-i@jichi.ac.jp.
Akimoto
Tetsu
T
Department of Internal Medicine, Division of Nephrology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
Saito
Osamu
O
Department of Internal Medicine, Division of Nephrology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
Ando
Yasuhiro
Y
Department of Internal Medicine, Division of Nephrology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
Muto
Shigeaki
S
Department of Internal Medicine, Division of Nephrology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
Kusano
Eiji
E
Department of Internal Medicine, Division of Nephrology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
D000118:Acetylglucosaminidase / Q000652:urine; D000208:Acute Disease; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use; D001168:Arthritis / Q000188:drug therapy; D004008:Diclofenac / Q000009:adverse effects* / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D009395:Nephritis, Interstitial / Q000139:chemically induced* / Q000188:drug therapy* / Q000652:urine; D051437:Renal Insufficiency / Q000139:chemically induced* / Q000188:drug therapy* / Q000652:urine; D001613:beta 2-Microglobulin / Q000652:urine
D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D001613:beta 2-Microglobulin; D004008:Diclofenac; D000118:Acetylglucosaminidase