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Kidney Week

Abstract: TH-PO065

Incidence, Pathology Findings, and Outcomes of Patients with Kidney Biopsy Proven Acute Interstitial Nephritis

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Khan, Neelofar R., Zucker School of Medicine at Hofstra Northwell, Great Neck, New York, United States
  • Bijol, Vanesa, Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York, United States
  • Wanchoo, Rimda, Zucker School of Medicine at Hofstra Northwell, Great Neck, New York, United States
  • Jhaveri, Kenar D., Zucker School of Medicine at Hofstra Northwell, Great Neck, New York, United States
  • Uppal, Nupur N., Zucker School of Medicine at Hofstra Northwell, Great Neck, New York, United States
Background

Acute interstitial Nephritis (AIN) is a common cause of AKI. However, there have been no recent studies that have reviewed the incidence, and/ or etiology of AIN.

Methods

Using our Health System’s kidney biopsy database, we reviewed charts of total 322 patients who underwent kidney biopsies in last 1 year. Patients with pathological diagnosis of AIN were analyzed for related clinical presentations and concurrent pathological findings. Patients with pure AIN were then compared to patients with AIN and associated kidney pathology findings using students t-tests and chi-square.

Results

AIN was present in 13% (42/322) patients. 38% had pure tubulo-interstitial diseases (Pure AIN) and 62% also had findings of other kidney diseases. 44% had simultaneous glomerular pathologies including primary and secondary FSGS (3 cases with collapsing glomerulopathy, 2 with secondary FSGS and 1 with primary FSGS), diabetic nephropathy, membranous nephropathy, immune complex GNs and lupus nephritis. To our surprise, concurrent oxalate deposition was seen in 12% patients. Mean age of patients with AIN was 54.2 years and 61% were females. Overall mean peak Scr was 3.9mg/dl and last known mean Scr post treatment was 2.5mg/dl. Mean proteinuria was 2.8 grams for both groups. There was no statistical difference in both groups in terms of age, proteinuria at baseline, and change Scr. Pure AIN group presented with a higher mean Scr (4.8) compared to AIN with concurrent glomerular disease group(3.2)(p= 0.09). Urine eosinophils were present only in 2 of 11 patients who were tested, and up trending peripheral eosinophilia was seen in only 9 patients. 10/42 patients received treatment with corticosteroids only. 11 patients required hemodialysis(HD). Pure AIN group was more likely to require HD (64% vs. 36%).
Beta lactam antibiotics (13.9%), NSAIDs (11.6%) and proton pump inhibitors (6.9%) were most common agents causing AIN.

Conclusion

AIN remains a prevalent cause of AKI. AIN with concurrent kidney pathology is more common than pure AIN. Patients with Pure AIN presented with higher Scr and were more likely to require treatment with HD. Although few patients with AIN were noted to have up-trending peripheral eosinophil counts, neither eosinophiluria nor peripheral eosinophilia were associated with predicting the kidney biopsy findings.