Clinicopathological Characteristics and Kidney Outcomes in Biopsy-Confirmed Acute Interstitial Nephritis

IF 5.7 2区医学 Q1 UROLOGY & NEPHROLOGY

Kidney International Reports Pub Date : 2024-12-01 DOI:10.1016/j.ekir.2024.09.026

Jing Miao , Charat Thongprayoon , Pajaree Krisanapan , Alessia Buglioni , Iasmina M. Craici , Wisit Cheungpasitporn

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Abstract

Introduction

Acute interstitial nephritis (AIN) is a significant cause of acute kidney injury, with varying etiologies and outcomes. This study aimed to examine the causes, clinical characteristics, management, and kidney outcomes in patients with biopsy-confirmed AIN.

Methods

A retrospective review was conducted on 166 patients diagnosed with AIN through kidney biopsy at Mayo Clinic between 2012 and 2023. Demographic, clinical, laboratory, and pathological data were collected. The primary outcome was kidney function recovery within the first 6 months. Statistical analyses included univariable and multivariable logistic regression, Kaplan-Meier survival analysis, and Cox proportional hazards modeling.

Results

Medications were the primary cause of AIN (67%), followed by autoimmune diseases (20%) and infections (6%). Within 6 months, 76% of patients achieved kidney recovery. Multivariable analysis indicated that moderate to severe interstitial fibrosis and tubular atrophy (IFTA) and dialysis requirement were associated with nonrecovery, whereas a prebiopsy diagnosis of AIN was positively associated with kidney recovery. Drug-related AIN had higher recovery rates compared to all other causes (81% vs. 66%, P = 0.04), and moderate to severe IFTA and dialysis need remained significant predictors of decreased recovery. Steroid therapy, used in 81% of patients, did not significantly influence kidney recovery in the overall cohort or in drug-induced AIN.

Conclusion

This study provides insights into the characteristics and outcomes of biopsy-confirmed AIN. IFTA and dialysis requirement were significant factors associated with worse kidney outcomes. These findings may help inform clinical management and prognostication in patients with AIN.

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查看原文本刊更多论文

活检证实的急性间质性肾炎的临床病理特征和肾脏预后。

急性间质性肾炎（AIN）是急性肾损伤的重要原因，其病因和预后各不相同。本研究旨在探讨活检证实的AIN患者的病因、临床特征、管理和肾脏预后。方法：回顾性分析2012年至2023年梅奥诊所通过肾活检诊断为AIN的166例患者。收集了人口学、临床、实验室和病理资料。主要终点是前6个月内的肾功能恢复。统计分析包括单变量和多变量logistic回归、Kaplan-Meier生存分析和Cox比例风险模型。结果：药物是AIN的主要原因（67%），其次是自身免疫性疾病（20%）和感染（6%）。6个月内，76%的患者肾脏恢复。多变量分析表明，中度至重度间质纤维化和肾小管萎缩（IFTA）和透析需求与不恢复相关，而活检前诊断AIN与肾脏恢复呈正相关。与所有其他原因相比，药物相关性AIN的恢复率更高（81% vs 66%, P = 0.04），中度至重度IFTA和透析需求仍然是恢复降低的重要预测因素。81%的患者使用类固醇治疗，对整个队列或药物性AIN的肾脏恢复没有显著影响。结论：本研究为活检证实的AIN的特征和预后提供了见解。IFTA和透析需求是与肾脏预后恶化相关的重要因素。这些发现可能有助于AIN患者的临床管理和预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Kidney International Reports Medicine-Nephrology

CiteScore

7.70

自引率

3.30%

发文量

1578

审稿时长

8 weeks

期刊介绍： Kidney International Reports, an official journal of the International Society of Nephrology, is a peer-reviewed, open access journal devoted to the publication of leading research and developments related to kidney disease. With the primary aim of contributing to improved care of patients with kidney disease, the journal will publish original clinical and select translational articles and educational content related to the pathogenesis, evaluation and management of acute and chronic kidney disease, end stage renal disease (including transplantation), acid-base, fluid and electrolyte disturbances and hypertension. Of particular interest are submissions related to clinical trials, epidemiology, systematic reviews (including meta-analyses) and outcomes research. The journal will also provide a platform for wider dissemination of national and regional guidelines as well as consensus meeting reports.