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Nephrology (Carlton) ; 17(8): 748-53, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22817666

RESUMO

BACKGROUND: The use and timing of steroids in the management of acute tubulointerstitial nephritis (ATIN) remains debatable. AIMS: To determine the incidence and aetiology of ATIN in our unit, and to examine trends in the use of steroids and their impact on renal outcomes. METHODS: Patients with a histological diagnosis of ATIN over a 9-year period were identified and divided into steroid-treated (StG) and steroid-naïve groups (SnG). Mean change in estimated glomerular filtration rate (eGFR) was determined. RESULTS: Forty-nine patients had ATIN as their main diagnosis, 67% of cases were drug-induced, and proton pump inhibitors (PPI) were the second commonest implicated drug category. Majority (75%) of patients received steroids, and eGFR improved to a significantly greater degree in these steroid-treated patients (3.4-fold improvement vs 2.0-fold in SnG; P < 0.05, unpaired t-test). Despite comparable eGFR at presentation (StG: 11.7; SnG: 15.4), steroid-treated patients were less likely to receive dialysis, although not significantly so (OR 0.27; 95% CI 0.06-1.15, P = 0.066, chi-squared test). However, there was no significant relation between the degree of eGFR improvement and delay in starting steroids (Pearson r = -0.25, P > 0.45), and no difference in eGFR at the time of last follow-up (StG: 33 ± 3; SnG: 32 ± 7; P > 0.9, unpaired t-test). CONCLUSION: StG patients had a greater degree of improvement in renal function, but with no correlation between degree of improvement in eGFR and delay in starting steroids, and similar eGFR values at final follow-up. PPI were the second commonest drug category among drug-induced cases.


Assuntos
Taxa de Filtração Glomerular/efeitos dos fármacos , Rim/efeitos dos fármacos , Nefrite Intersticial/tratamento farmacológico , Esteroides/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/efeitos adversos , Biópsia , Distribuição de Qui-Quadrado , Inglaterra/epidemiologia , Feminino , Humanos , Incidência , Rim/patologia , Rim/fisiopatologia , Masculino , Pessoa de Meia-Idade , Nefrite Intersticial/diagnóstico , Nefrite Intersticial/epidemiologia , Nefrite Intersticial/fisiopatologia , Razão de Chances , Inibidores da Bomba de Prótons/efeitos adversos , Recuperação de Função Fisiológica , Diálise Renal , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
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