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Acute interstitial nephropathies (AIN) represent a common cause of acute renal failure (ARF). Diagnosis is based on a combination of anamnestic, clinical, and biological factors. Histology may sometimes be essential for diagnosis. The aim of this study was to describe the epidemiological, clinical, laboratory, histological, and etiological aspects of AIN and to specify the therapeutic and evolutionary modalities.
This was a retrospective observational descriptive study with an analytical approach focusing on histologically proven AIN cases between January 2006 and December 2021.
The study included 36 patients. The average age was 50.5 years with a predominance of females (58.3%). Biologically, creatinine levels averaged 691.5 µmol/l [141.0; 1949.0]. Eosinophilia was found in 14 cases (38.8%). Renal histology confirmed the diagnosis of AIN by showing the presence of an inflammatory interstitial infiltrate, with inflammatory granulomas present in 5 cases. Interstitial edema and tubulitis lesions were observed in 25 (69%) and 4 cases (11%), respectively. Drug-induced etiology was the most common (41.66%), primarily associated with non-steroidal anti-inflammatory drugs and antibiotics. Corticosteroid therapy was prescribed for 93.3% of these patients. Notably, our study identified two causes of AIN that have not been previously described in the literature: granulomatous AIN associated with a triple digestive parasitic infection and pseudosarcoidosis AIN secondary to Rituximab treatment prescribed for mantle cell lymphoma. The presence of fibrosis was the sole predictor of progression to chronic renal failure (CRF). We identified certain parameters that were statistically significant in drug-induced AIN compared to other etiologies: cutaneous signs, eosinophilia, and microscopic hematuria.
Immuno-allergic causes are the most frequently implicated in AIN. Renal prognosis is often favorable in cases of AIN. Nevertheless, they can progress to CRF in cases of diagnostic and therapeutic delay.