Acute interstitial nephritis: clinical features and response to corticosteroid therapy

Nephrol Dial Transplant. 2004 Nov;19(11):2778-83. doi: 10.1093/ndt/gfh485. Epub 2004 Aug 31.


Background: Acute interstitial nephritis (AIN) is a recognized cause of reversible acute renal failure characterized by the presence of an interstitial inflammatory cell infiltrate.

Methods: In order to evaluate the clinical characteristics and management of this disorder, we performed a retrospective study of all cases of AIN found by reviewing 2598 native renal biopsies received at our institution over a 12 year period. Presenting clinical, laboratory and histological features were identified, as was clinical outcome with specific regard to corticosteroid therapy response.

Results: AIN was found in 2.6% of native biopsies, and 10.3% of all biopsies performed in the setting of acute renal failure during the period analysed (n = 60). The incidence of AIN increased progressively over the period observed from 1 to 4% per annum. AIN was drug related in 92% of cases and appeared to be idiopathic in the remainder. The presenting symptoms included oliguria (51%), arthralgia (45%), fever (30%), rash (21%) and loin pain (21%). Median serum creatinine at presentation was 670 micromol/l [interquartile range (IQR) 431-1031] and 58% of cases required acute renal replacement therapy. Corticosteroid therapy was administered in 60% of cases. Serum creatinine at baseline was similar in the corticosteroid-treated and conservatively managed groups; 700 micromol/l (IQR 449-1031) vs 545 micromol/l (IQR 339-1110) P = 0.4. In this, the largest retrospective series to date, we did not detect a statistically significant difference in outcome, as determined by serum creatinine, between those patients who received corticosteroid therapy and those who did not, at 1, 6 and 12 months following presentation.

Conclusion: The results of this study do not support the routine administration of corticosteroid therapy in the management of AIN.

MeSH terms

  • Acute Disease
  • Aged
  • Biopsy
  • Creatinine / blood
  • Female
  • Glucocorticoids / therapeutic use*
  • Humans
  • Male
  • Methylprednisolone / therapeutic use*
  • Middle Aged
  • Nephritis, Interstitial / diagnosis
  • Nephritis, Interstitial / drug therapy*
  • Nephritis, Interstitial / pathology
  • Retrospective Studies
  • Treatment Outcome


  • Glucocorticoids
  • Creatinine
  • Methylprednisolone