Abstract
BackgroundA renal biopsy is needed to define active inflammatory infiltration and guide therapeutic management in drug-induced acute tubulointerstitial nephritis (D-ATIN). However, factors such as various contraindications, refusal of informed consent and limited technical support may stop the biopsy process. It is thus of great importance to explore approaches that could deduce probable pathologic changes.MethodsA total of 81 biopsy-proven D-ATIN patients were enrolled from a prospective cohort of ATIN patients at Peking University First Hospital. The systemic inflammation score (SIS) was developed based on the CRP and ESR levels at biopsy, and patients were divided into high-SIS, median-SIS, and low-SIS groups. The demographic data, clinicopathologic features, and renal outcomes were compared.ResultsThe SIS was positively correlated with inflammatory cell infiltration and was inversely correlated with interstitial fibrosis. The number of interstitial inflammatory cells increased significantly with increasing SISs. The proportions of neutrophils and plasma cells were the highest in the high-SIS group compared with the other two groups. Prednisone (30–40 mg/day) was prescribed in all patients. The high-SIS group tended to have more favorable renal restoration than the other two groups. By 12 months postbiopsy, a decreased eGFR (< 60 mL/min/1.73 m2) was observed in 66.7% of medium-SIS patients, 32.4% of high-SIS patients, and 30.4% of low-SIS patients.ConclusionThe SIS was positively correlated with active tubulointerstitial inflammation and therefore could help to aid therapeutic decisions in D-ATIN.
Highlights
A renal biopsy is needed to define active inflammatory infiltration and guide therapeutic management in drug-induced acute tubulointerstitial nephritis (D-Acute tubulointerstitial nephritis (ATIN))
It is of great importance for those patients clinically suspected of having drug-induced acute tubulointerstitial nephritis (D-ATIN), in whom renal biopsy cannot be conducted, to explore approaches that could deduce probable pathologic changes and indicate the severity of interstitial inflammatory cell infiltration, which could help make therapeutic decisions
Patients who were clinicopathologically diagnosed with D-ATIN from January 1, 2005, to December 31, 2018, and who were followed for at least 12 months were screened in a prospective cohort of ATIN patients in Peking University First Hospital as previously described [21]
Summary
A renal biopsy is needed to define active inflammatory infiltration and guide therapeutic management in drug-induced acute tubulointerstitial nephritis (D-ATIN). A renal biopsy is needed to make a definitive diagnosis of D-ATIN and reveals the activity and severity of interstitial inflammation that usually directs immunosuppressive treatment [11,12,13] Factors such as various contraindications, refusal of informed consent and limited technical support may stop the process of renal biopsy. It is of great importance for those patients clinically suspected of having D-ATIN, in whom renal biopsy cannot be conducted, to explore approaches that could deduce probable pathologic changes and indicate the severity of interstitial inflammatory cell infiltration, which could help make therapeutic decisions
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