From the Research
Thiazide diuretics can cause interstitial nephritis, an uncommon but potentially serious adverse effect, and their use should be carefully considered in patients with a history of kidney disease or those at risk of developing it 1. When caused by thiazides like hydrochlorothiazide, chlorthalidone, or indapamide, interstitial nephritis typically develops as a hypersensitivity reaction within days to weeks of starting the medication. Patients may present with fever, rash, eosinophilia, and declining kidney function. Some may have minimal symptoms with only laboratory abnormalities.
Key Considerations
- If thiazide-induced interstitial nephritis is suspected, the medication should be discontinued immediately 2.
- Recovery usually occurs within weeks after stopping the offending drug, though some patients may require a short course of corticosteroids if symptoms are severe or persistent.
- Kidney function should be monitored regularly after discontinuation until it returns to baseline.
- Alternative antihypertensive medications from different classes should be considered for patients with a history of thiazide-induced interstitial nephritis, as cross-reactivity between different thiazides is possible.
Mechanism and Risk Factors
- The mechanism involves drug-specific T-cell-mediated immune responses that trigger inflammation within the kidney tissue.
- Risk factors for thiazide-induced interstitial nephritis include advanced age, female sex, and pre-existing kidney disease 3.
- The use of thiazide diuretics in patients with advanced chronic kidney disease should be carefully considered, as recent data suggest that they may be beneficial for blood pressure control in addition to natriuresis in existing CKD 1.