Early steroid treatment improves the recovery of renal function in patients with drug-induced acute interstitial nephritis.

The role of steroid treatment in drug-induced acute interstitial nephritis (DI-AIN) is controversial. We performed a multicenter retrospective study to determine the influence of steroids in 61 patients with biopsy-proven DI-AIN, 52 of whom were treated with steroids. The responsible drugs were antibiotics (56%), non-steroidal anti-inflammatory drugs (37%) or other drugs. The final serum creatinine was significantly lower in treated patients while almost half of untreated patients remained on chronic dialysis. Among treated patients, over half showed a complete recovery of baseline renal function, whereas the rest remained in renal failure. There were no significant initial differences between these two subgroups in terms of duration or dosage of steroids. After withdrawal of the presumed causative drug, we found that when steroid treatment was delayed (by an average of 34 days) renal function did not return to baseline levels compared to those who received steroid treatment within the first 2 weeks after withdrawal of the offending agent. We found a significant correlation between the delay in steroid treatment and the final serum creatinine. Renal biopsies, including three patients who underwent a second biopsy, showed a progression of interstitial fibrosis related to the delay in steroid treatment. Our study shows that steroids should be started promptly after diagnosis of DI-AIN to avoid subsequent interstitial fibrosis and an incomplete recovery of renal function.

[Complementary artificial nutrition in kidney failure]. / Nutrición artificial complementaria en la insuficiencia renal.

Denutrition of the uremic patient is a substantial contributing factor to the high rate of morbimortality. At the present time there are no resources which slow the catabolic situation conditioned by humoral or hormonal factors, but resources are available which act on the nutritional factors. The aim of this paper is to study the effect of additional administration of a complete enteral diet, but high in calories and in proteins, on the nutrition of dialysis patients. Six patients undergoing periodic hemodialysis and without metabolic illness were selected: 236 ml of the solution was administered orally on a daily basis for two months. They were studied statistically using the SIGMA Program, with application of the comparison of paired averages, the variations of anthropometric and analytical data and urea kinetics. The results revealed a significant body weight increase, from 58 to 60 kg, and of the tricipital fold from 10 to 12 cm: both variations were statistically significant (p < 0.01). There were no variations in the analytical data, or in the urea kinetics (the PCR was 0.8 g/kg/day and the Kt/V was 0.8). It is concluded that it significantly improves the nutritional state, there are no side effects and it does not detract from the efficacy of the dialysis. Therefore, and although the indication for which it was designed was for predialysis patients, we think that those under periodic hemodialysis--and, form the same reasons, acute kidney failure patients--might be areas for the use of this product.