From the Guidelines
The recommended treatment for acute interstitial nephritis (AIN) primarily involves removing the offending agent and providing supportive care, with corticosteroid therapy, such as prednisone at 0.5-1 mg/kg/day, being considered for cases that don't improve with withdrawal of the offending agent, as suggested by the most recent guideline update 1.
Key Considerations
- Removing the offending agent, typically a medication, is the first step in treating AIN.
- Supportive care includes maintaining fluid and electrolyte balance, avoiding nephrotoxic agents, and monitoring kidney function.
- Corticosteroid therapy, such as prednisone, is often used for cases that don't improve with withdrawal of the offending agent, with a typical dose of 0.5-1 mg/kg/day for 1-2 weeks, followed by a gradual taper over 4-6 weeks, as recommended by 1.
- The effectiveness of treatment depends on early diagnosis, prompt removal of the offending agent, and addressing the underlying inflammatory process.
Management of Immune-Related Adverse Events
- The American Society of Clinical Oncology (ASCO) guideline update 1 provides recommendations for the management of immune-related adverse events, including nephritis or acute kidney injury (AKI).
- The guideline suggests that patients with new elevations in creatinine should have therapy held while other potential causes are evaluated, and that renal biopsy is typically not necessary or recommended unless the AKI is refractory to steroids and other immunosuppressant agents.
High-Dose Steroids and PPI in Acute Interstitial Nephritis
- There is no clear evidence to support the use of high-dose steroids and PPI in AIN, and the treatment should be individualized based on the severity of the disease and the patient's response to treatment, as suggested by 1 and 1.
- The use of PPI is not recommended as a standard treatment for AIN, and its use should be based on the patient's specific needs and medical history.
From the Research
Treatment of Acute Interstitial Nephritis
The treatment of acute interstitial nephritis (AIN) typically involves the discontinuation of the offending drug and the use of corticosteroids to reduce inflammation.
- The use of high-dose steroids, such as prednisolone, has been shown to be effective in improving renal function in patients with AIN 2, 3, 4.
- A study published in 2021 found that oral prednisolone treatment starting with 60 mg daily and tapered over 8 weeks may be effective in improving renal function in patients with AIN 2.
- Another study published in 2018 found that the use of high-dose corticosteroids for 3 weeks or treatment duration >8 weeks were not associated with better recovery of kidney function 3.
- Proton pump inhibitors (PPIs), such as omeprazole, have been associated with AIN, and discontinuation of the offending drug is essential in the treatment of this condition 5, 6.
Role of PPIs in Acute Interstitial Nephritis
PPIs, such as omeprazole, have been implicated in the development of AIN.
- A case study published in 2024 found that omeprazole was associated with AIN in a 59-year-old male patient, and discontinuation of the drug and treatment with prednisone were necessary to improve renal function 5.
- Another study published in 2004 found that omeprazole was associated with AIN in two patients, highlighting the importance of considering PPIs as a potential cause of AIN 6.
Recommended Treatment
The recommended treatment for AIN typically involves the discontinuation of the offending drug and the use of corticosteroids to reduce inflammation.
- A prospective randomized trial published in 2018 found that oral prednisolone and high-dose intravenous pulse steroid therapy were equally effective in the treatment of drug-induced AIN, if used early 4.
- The use of high-dose steroids, such as prednisolone, has been shown to be effective in improving renal function in patients with AIN, but the optimal duration of treatment is still unclear 2, 3, 4.