title: Clinical characteristics, causes and outcomes of acute interstitial nephritis in the elderly.
abstract: Acute interstitial nephritis (AIN) is an important cause of acute kidney injury (AKI), and its prevalence in the elderly may be increasing. It is largely unknown whether AIN in the elderly is similar to that in younger adults; therefore, we investigated the causes and characteristics of AIN in 45 elderly patients (65 years and older) and in 88 younger adults (18-64 years old). Compared with younger patients, the elderly had significantly more drug-induced AIN (87 vs. 64%), proton pump inhibitor-induced AIN (18 vs. 6%), but significantly less AIN due to autoimmune or systemic causes (7 vs. 27%). The two most common culprit drugs in the elderly were penicillin and omeprazole. Compared with younger patients, the elderly had higher prevalence of baseline CKD, higher peak creatinine, and more need for dialysis, all of which were significant. Among the elderly, 86% showed partial or complete recovery within 6 months. Significantly shorter delays in initiation of steroids correlated with recovery at 6 months. Lack of early recovery tended to correlate with progressive CKD. Compared with antibiotic-induced AIN, proton pump inhibitor-induced AIN had less severe AKI, but a longer duration of drug exposure, and was less likely to recover by 6 months, all significant. Thus, the vast majority of AIN cases in the elderly are due to drugs, primarily owing to proton pump inhibitors and antibiotics, while AIN of autoimmune or systemic origin is uncommon.
authors.affiliation: Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Angela K
authors.initials: AK
authors.lastname: Muriithi
authors.affiliation: Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Nelson
authors.initials: N
authors.lastname: Leung
authors.affiliation: Division of Nephrology, Columbia University, College of Physicians and Surgeons, New York, New York, USA.
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Valeri
authors.affiliation: Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Lynn D
authors.initials: LD
authors.lastname: Cornell
authors.affiliation: Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Sethi
authors.affiliation: Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Fidler
authors.affiliation: Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Samih H
authors.initials: SH
authors.lastname: Nasr
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D001327:Autoimmune Diseases / Q000150:complications; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009395:Nephritis, Interstitial / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D054328:Proton Pump Inhibitors / Q000009:adverse effects; D013256:Steroids / Q000627:therapeutic use; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors; D013256:Steroids; D003404:Creatinine