Clinical Characteristics of Childhood Acute Tubulointerstitial Nephritis

Pediatr Int. 2020 Oct 5. doi: 10.1111/ped.14495. Online ahead of print.

Abstract

Background: Acute tubulointerstitial nephritis (ATIN), a rare cause of acute kidney injury (AKI) in children that can lead to chronic kidney disease (CKD). The aim of this study was to describe presenting features, the etiology and clinical characteristics of childhood ATIN and evaluate treatment modalities and renal outcomes.

Methods: The study included 38 patients who have been diagnosed with ATIN, were younger than 18 years old and were admitted for at least six months of follow-up.

Results: The median age at diagnosis was 13.1 years (range 1.2 years-16.6 years). The female/male ratio was 1.37. The most common symptoms were abdominal pain (65.7%) and nausea/vomiting (55.2%). Twenty-three of the patients had a history of drug intake (60.5%), and the most active drugs in the etiology were non-steroidal anti-inflammatory drugs (56.5%). Eleven patients were given steroid therapy due to severe kidney involvement and rapid increases in serum creatinine values, and ten of those patients were drug-related ATIN cases. Other patients were given symptomatic treatment. Four patients needed several sessions of dialysis due to the severity of their acute renal failure. The follow-up creatinine and estimated glomerular filtration rate (eGFR) levels were not statistically different between the symptomatic and corticosteroid treated groups (p > 0.05).

Conclusion: Although our study was unable to show the beneficial effect of corticosteroid therapy on extent of renal recovery, the use of steroids may be preferable in severe nephritis because of the rapid recovery of eGFR with corticosteroid therapy.

Keywords: acute kidney injury; corticosteroid; renal outcome; tubulointerstitial nephritis.