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 TIN is discontinuation of potentially offending agent, as well as beginning supportive care. The majority of patients involved with drug-induced AIN, improve spontaneously; however, renal function may not return to previous condition.
No additional measures is needed among patients with minimal rise in the serum creatinine or those who show betterment after
discontinuation of offending agent; otherwise if renal failure persists after removing the culprit drug, obtaining a renal biopsy and attempt glucocorticoids therapy for patients with biopsy-confirmed AIN must be considered.
Medical Therapy
The mainstay of treatment for TIN is discontinuation of potentially offending agent, as well as following measures:
- Supportive care and maintenance adequate hydration
- Symptomatic relief for fever, rash, and systemic symptoms
- Control of blood pressure
- Correct electrolyte imbalances
- Reduce exposure to other nephrotoxic agents
The majority of patients involved with drug-induced AIN, improve spontaneously, and no additional measures is needed among patients with minimal rise in the serum creatinine or those who show betterment after discontinuation of offending agent; otherwise if renal failure persists after removing the culprit drug, obtaining a renal biopsy and attempt glucocorticoids therapy for patients with biopsy-confirmed AIN must be considered.
Glucocorticoid therapy
- Glucocorticoid therapy is recommended among patients with critical rise in the serum creatinine , or those whose renal failure persists after removing the offending agents; although before beginning of glucocorticoid therapy obtaining a kidney biopsy and confirm the diagnosis is necessary.
first line:
prednisone 1 mg/kg per day (to a maximum of 40 to 60 mg) for a minimum of one to two weeks, beginning a gradual taper after the serum creatinine has returned to or near baseline, for a total therapy duration of two to three months.