Clinical Features, Outcomes, and Response to Corticosteroid Treatment of Acute Tubulointerstitial Nephritis: A Single-Centre Retrospective Cohort Study in the Czech Republic.
Oskar Zakiyanov, Yaprak Ḉaḡlar, Romana Ryšavá, Eva Jančová, Dita Maixnerová, Doubravka Frausová, Tomáš Indra, Eva Honsová, Vítězslav Kříha, Ivan Rychlík, Vladimír Tesař, Věra Čertíková Chábová
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Abstract
Introduction: Acute tubulointerstitial nephritis (ATIN) is a well-recognized cause of acute kidney injury (AKI) due to the tubulointerstitial inflammation. The aim of this study was to explore the clinical features, outcomes, and responses to corticosteroid treatment in patients with ATIN.
Methods: Patients with biopsy-proven ATIN, who were diagnosed between 1994 and 2016 at the Department of Nephrology, Charles University, First Faculty of Medicine, and General University Hospital in Prague, were included in the study. Patient demographics, the aetiological and clinical features, the treatment given, and the outcome at 1 year of follow-up were extracted from patient records.
Results: A total of 103 ATIN patients were analysed, of which 68 had been treated with corticosteroids. There was no significant difference in the median serum creatinine 280 (169-569) µmol/L in the conservatively managed group versus 374 (249-558) µmol/L in the corticosteroid-treated group, p = 0.18, and dependence on dialysis treatment at baseline at the time of biopsy (10.3 vs. 8.6%). During the 1 year of follow-up, those ATIN patients who had been treated with corticosteroids did better and showed greater improvement in kidney function, determined as serum creatinine difference from baseline and from 1 month over 1-year period (p = 0.001).
Conclusions: This single-centre retrospective cohort study supports the beneficial role of the administration of corticosteroid therapy in the management of ATIN.
急性肾小管间质性肾炎(ATIN)是公认的急性肾损伤(AKI)的原因，是由于肾小管间质性炎症引起的。本研究的目的是探讨ATIN患者的临床特征、结局和对皮质类固醇治疗的反应。方法:纳入1994-2016年间在布拉格查尔斯大学第一医学院肾内科和综合大学医院诊断的活检证实为ATIN的患者。从患者记录中提取患者人口统计学，病因学和临床特征，给予的治疗以及一年随访的结果。结果:共分析103例ATIN患者，其中68例已接受皮质类固醇治疗。保守治疗组的血清肌酐中位数为280(169-569)µmol/l，皮质类固醇治疗组为374(249-558)µmol/l, p = 0.18，活检时基线对透析治疗的依赖性无显著差异(10.3% vs 8.6%)。在一年的随访中，那些接受皮质类固醇治疗的ATIN患者表现更好，肾功能改善更大，以血清肌酐与基线和1个月与1年期间的差异来确定(p=0.001)。结论:这项单中心回顾性队列研究支持皮质类固醇治疗在治疗ATIN中的有益作用。
期刊介绍：
This journal comprises both clinical and basic studies at the interface of nephrology, hypertension and cardiovascular research. The topics to be covered include the structural organization and biochemistry of the normal and diseased kidney, the molecular biology of transporters, the physiology and pathophysiology of glomerular filtration and tubular transport, endothelial and vascular smooth muscle cell function and blood pressure control, as well as water, electrolyte and mineral metabolism. Also discussed are the (patho)physiology and (patho) biochemistry of renal hormones, the molecular biology, genetics and clinical course of renal disease and hypertension, the renal elimination, action and clinical use of drugs, as well as dialysis and transplantation. Featuring peer-reviewed original papers, editorials translating basic science into patient-oriented research and disease, in depth reviews, and regular special topic sections, ''Kidney & Blood Pressure Research'' is an important source of information for researchers in nephrology and cardiovascular medicine.
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