Original InvestigationPathogenesis and Treatment of Kidney DiseaseBiopsy-Proven Acute Interstitial Nephritis, 1993-2011: A Case Series
Section snippets
Study Population
Retrospective review of all native kidney biopsies evaluated in the Renal Pathology Laboratory at Mayo Clinic, Rochester, from 1993 through 2011 identified 133 Mayo Clinic patients with AIN without concurrent glomerulonephritis. We excluded patients younger than 18 years, patients with glomerulonephritis or primary vascular disease, and those with transplant biopsies, as well as outside institution referrals.
Pathologic Studies
A pathologic diagnosis of AIN required the presence of prominent interstitial
Baseline Clinical and Demographic Data
Table 1 lists demographic and clinical characteristics of all 133 patients with AIN and compares drug-induced AIN to AIN from other causes. Most patients (58%) were hospitalized and developed AKI during the course of this hospitalization. Baseline serum creatinine levels (median, 1.1 mg/dL) were available for 109 patients, and 48 (44%) patients had CKD as defined by baseline eGFR < 60 mL/min/1.73 m2. Prior to biopsy, AIN was suspected in only 55% of cases. Close to half the patients had pyuria and
Discussion
A main cause of AKI, especially in hospitalized patients, AIN accounts for 15%-27% of cases; the incidence of AIN may be increasing, possibly due to more detection.21, 22, 23, 24 Over time, since AIN was first described,2, 3 when infections were by far the most common culprit, the cause of AIN has changed. Currently, drugs are responsible for most cases.7, 8, 9, 10 Two studies published in 2000 and 2004 that included a total of 124 patients with AIN found NSAIDs to be the most common culprit
Acknowledgements
Support: None.
Financial Disclosure: The authors declare that they have no relevant financial interests.
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