title: Acute tubulointerstitial nephritis, treatment with steroid and impact on renal outcomes.
abstract: BACKGROUND
  The use and timing of steroids in the management of acute tubulointerstitial nephritis (ATIN) remains debatable.
  
  
  OBJECTIVE
  To determine the incidence and aetiology of ATIN in our unit, and to examine trends in the use of steroids and their impact on renal outcomes.
  
  
  METHODS
  Patients with a histological diagnosis of ATIN over a 9-year period were identified and divided into steroid-treated (StG) and steroid-naïve groups (SnG). Mean change in estimated glomerular filtration rate (eGFR) was determined.
  
  
  RESULTS
  Forty-nine patients had ATIN as their main diagnosis, 67% of cases were drug-induced, and proton pump inhibitors (PPI) were the second commonest implicated drug category. Majority (75%) of patients received steroids, and eGFR improved to a significantly greater degree in these steroid-treated patients (3.4-fold improvement vs 2.0-fold in SnG; P < 0.05, unpaired t-test). Despite comparable eGFR at presentation (StG: 11.7; SnG: 15.4), steroid-treated patients were less likely to receive dialysis, although not significantly so (OR 0.27; 95% CI 0.06-1.15, P = 0.066, chi-squared test). However, there was no significant relation between the degree of eGFR improvement and delay in starting steroids (Pearson r = -0.25, P > 0.45), and no difference in eGFR at the time of last follow-up (StG: 33 ± 3; SnG: 32 ± 7; P > 0.9, unpaired t-test).
  
  
  CONCLUSIONS
  StG patients had a greater degree of improvement in renal function, but with no correlation between degree of improvement in eGFR and delay in starting steroids, and similar eGFR values at final follow-up. PPI were the second commonest drug category among drug-induced cases.
authors: Royal Devon and Exeter Hospital, Exeter, UK. muhammad.raza@glos.nhs.uk
authors: Muhammad N
authors: MN
authors: Raza
authors: Muhammad
authors: M
authors: Hadid
authors: Charles E
authors: CE
authors: Keen
authors: Coralie
authors: C
authors: Bingham
authors: Andrew H J
authors: AH
authors: Salmon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D001706:Biopsy; D016009:Chi-Square Distribution; D004739:England / Q000453:epidemiology; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects*; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000187:drug effects* / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009395:Nephritis, Interstitial / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D016017:Odds Ratio; D054328:Proton Pump Inhibitors / Q000009:adverse effects; D020127:Recovery of Function; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D013256:Steroids / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors; D013256:Steroids