Abstract: TH-PO107
Prognostic Biomarkers of Kidney Function and Steroid Responsiveness After Acute Interstitial Nephritis
Session Information
- AKI: Biomarkers, Drugs, Onco-Nephrology
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Moledina, Dennis G., Yale School of Medicine, New Haven, Connecticut, United States
- Wilson, Francis Perry, Yale School of Medicine, New Haven, Connecticut, United States
- Perazella, Mark A., Yale School of Medicine, New Haven, Connecticut, United States
- Moeckel, Gilbert W., Yale University School of Medicine, New Haven, Connecticut, United States
- Cantley, Lloyd G., Yale University School of Medicine, New Haven, Connecticut, United States
- Parikh, Chirag R., Johns Hopkins University, Baltimore, Maryland, United States
Background
Predictors of kidney injury, inflammation and function after AIN can guide therapeutic strategies.
Methods
In participants with adjudicated AIN, we examined the relationship of conventional and novel biomarkers of kidney structure and function (glomerular filtration rate [eGFR] before biopsy, histology), injury (urine uromodulin, NGAL, KIM-1, IL-18, microscopy) and inflammation (TNFa, IFNg, IL4, IL5, IL6, IL9, IL13) with eGFR measured 6 months (6m) after biopsy controlling for eGFR before biopsy and albuminuria. We also evaluated the impact of steroids on 6m eGFR.
Results
We ascertained 6m eGFR in 51 (93%) out of 55 participants. Mean (SD) eGFR before, during, and 6m after AIN was 41.6 (26.3), 15.6 (10.5), and 33.4 (24.3) ml/min, respectively. Urine uromodulin at time of AIN diagnosis was independently associated with 6m eGFR (Figure), whereas other novel biomarkers were not associated with 6m eGFR. Among the histological features, higher interstitial fibrosis/tubular atrophy (IF/TA) was associated with lower 6m eGFR, whereas interstitial infiltrate and tubular injury were associated with higher 6m eGFR. We noted that steroid use was associated with higher 6m eGFR in those with ≥25% inflammatory infiltrate on biopsy but not in those with <25% involvement, and in those with urine IL-9 level above the median (0.75 ng/mg) but not in those with IL-9 levels below the median.
Conclusion
Higher urine uromodulin level at the time of AIN diagnosis was associated with higher 6m eGFR independent of prebiopsy eGFR and albuminuria. Steroid use was associated with higher 6m eGFR in those with active inflammation at the time of biopsy. These findings could help prognosticate kidney function after AIN and guide initiation of steroid therapy.
Funding
- NIDDK Support