From the Research
The dose of prednisone for chronic interstitial nephritis is typically started at 0.5-1 mg/kg/day, approximately 30-60 mg daily for an average adult, as seen in the study by 1, which is the most recent and highest quality study available. For drug-induced or immune-mediated cases, prednisone is then gradually tapered over 8-12 weeks based on clinical response. Treatment duration generally ranges from 3-6 months, with close monitoring of kidney function. Before starting prednisone, the underlying cause should be identified and removed if possible (such as discontinuing an offending medication). Some key points to consider in the treatment of chronic interstitial nephritis include:
- Identifying and removing the underlying cause of the condition
- Monitoring for common steroid side effects, including hyperglycemia, hypertension, weight gain, and increased infection risk
- Considering steroid-sparing agents like mycophenolate mofetil or azathioprine for maintenance therapy in recurrent or steroid-dependent cases
- Balancing the use of prednisone against potential adverse effects, especially in patients with reduced kidney function, as noted in the study by 2. The study by 3 also compared the efficacy of oral prednisolone versus high-dose intravenous pulse steroid therapy in the treatment of drug-induced acute interstitial nephritis, and found that both treatments were equally effective when used early. However, the study by 1 provides the most relevant and recent guidance on the dose and duration of prednisone treatment for chronic interstitial nephritis. It is essential to prioritize the patient's morbidity, mortality, and quality of life when making treatment decisions, and to carefully weigh the potential benefits and risks of prednisone treatment in each individual case, as emphasized in the studies by 4 and 5.