Abstract
Acute tubulointerstitial nephritis (ATIN) is a common cause of acute kidney injury. Although haematuria is a risk factor for the development of renal disease, no previous study has analyzed the significance of haematuria in ATIN. Retrospective, observational analysis of 110 patients with biopsy-proven ATIN was conducted. Results: Haematuria was present in 66 (60%) ATIN patients. A higher percentage of ATIN patients with haematuria had proteinuria than patients without haematuria (89.4% vs. 59.1%, p = 0.001) with significantly higher levels of proteinuria (median (interquartile range) protein:creatinine ratio 902.70 (513–1492) vs. 341.00 (177–734) mg/g, p <0.001). Moreover, those patients with more haematuria intensity had a higher urinary protein:creatinine ratio (1352.65 (665–2292) vs. 849.60 (562–1155) mg/g, p = 0.02). Those patients with higher proteinuria were more likely to need renal replacement therapy (22.7 vs. 0%, p = 0.03) and to suffer relapse (4 vs. 0%, p = 0.03). At the end of follow up, haematuric ATIN patients had higher serum creatinine levels (3.19 ± 2.91 vs. 1.91 ± 1.17 mg/dL, p = 0.007), and a trend towards a higher need for acute dialysis (7 vs. 1%, p = 0.09) and renal replacement therapy (12.1 vs. 2.3%, p = 0.12). Haematuria is common in ATIN and it is associated with worse renal function outcomes.
Highlights
Acute tubulointerstitial nephritis (ATIN) is a common cause of acute kidney injury (AKI) [1], representing 15–25% of cases [2,3] where the indication for renal biopsy was AKI
Among the 174 ATIN patients initially identified, 119 (68.4%) had urinary dipstick data; of these, 110 patients had a pathological diagnosis of AKI alone and were included in the analysis
Haematuria is a common finding in patients with ATIN, our results suggest that clinicians pay little attention to haematuria in this condition as haematuria data were recorded in 60% of ATIN patients
Summary
Acute tubulointerstitial nephritis (ATIN) is a common cause of acute kidney injury (AKI) [1], representing 15–25% of cases [2,3] where the indication for renal biopsy was AKI. Haematuria has been found to predict renal outcome in IgA nephropathy, being associated with an increased risk of ESRD after 10 years of follow-up [9]. Disappearance of both haematuria and proteinuria has recently been proposed to define clinical remission in IgA nephropathy [10,11]. Hb induces oxidative stress, cell death, and pro-inflammatory and pro-fibrotic responses [13]
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