Interstitial nephritis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohsen Basiri M.D.
Overview
The mainstay of treatment for tubulointerstitial nephritis is discontinuation of potentially offending agent. The majority of patients due to drug-induced interstitial nephritis, improve spontaneously with supportive care. However, renal function may not return to baseline. In conditions with persisting renal failure it is recommended to obtain a renal biopsy and trial of glucocorticoids therapy for patients with AIN on biopsy.
Medical Therapy
The mainstay of treatment for tubulointerstitial nephritis is discontinuation of potentially offending agent. Additional treatment measures include:
- Supportive care:
- Control of blood pressure with anti-hypertensives.
- Correction of electrolyte imbalances
- No additional measures are recommend for patients who responded to supportive measures
- In conditions with persisting renal failure it is recommended to obtain a renal biopsy and trial of glucocorticoids therapy for patients with AIN on biopsy..[1][2]
- Preferred regimen (1): Prednisone 1 mg/kg per day PO or equivalent IV dose (maximum of 40 to 60 mg)
- Note: Recommended for 1-2 weeks, followed by gradual tappering.[3]
- Alternative regimen (1): Mycophenolate mofetil[4]
- Note: Indicated in glucocorticoid resistant or contraindicated cases.
- Preferred regimen (1): Prednisone 1 mg/kg per day PO or equivalent IV dose (maximum of 40 to 60 mg)
References
- ↑ Baker, R. J.; Pusey, C. D. (2004). "The changing profile of acute tubulointerstitial nephritis". Nephrology Dialysis Transplantation. 19 (1): 8–11. doi:10.1093/ndt/gfg464. ISSN 0931-0509.
- ↑ Michael R. Clarkson, Louise Giblin, Fionnuala P. O'Connell, Patrick O'Kelly, Joseph J. Walshe, Peter Conlon, Yvonne O'Meara, Anthony Dormon, Eileen Campbell & John Donohoe (2004). "Acute interstitial nephritis: clinical features and response to corticosteroid therapy". Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 19 (11): 2778–2783. doi:10.1093/ndt/gfh485. PMID 15340098. Unknown parameter
|month=ignored (help) - ↑ J. Rossert (2001). "Drug-induced acute interstitial nephritis". Kidney international. 60 (2): 804–817. doi:10.1046/j.1523-1755.2001.060002804.x. PMID 11473672. Unknown parameter
|month=ignored (help) - ↑ Dean C. Preddie, Glen S. Markowitz, Jai Radhakrishnan, Thomas L. Nickolas, Vivette D. D'Agati, Joshua A. Schwimmer, Mark Gardenswartz, Raquel Rosen & Gerald B. Appel (2006). "Mycophenolate mofetil for the treatment of interstitial nephritis". Clinical journal of the American Society of Nephrology : CJASN. 1 (4): 718–722. doi:10.2215/CJN.01711105. PMID 17699278. Unknown parameter
|month=ignored (help)