Aetiology, course and treatment of acute tubulointerstitial nephritis in paediatric patients: a cross-sectional web-based survey.
acute renal failure
paediatric nephrology
paediatrics
Journal
BMJ open
ISSN: 2044-6055
Titre abrégé: BMJ Open
Pays: England
ID NLM: 101552874
Informations de publication
Date de publication:
28 05 2021
28 05 2021
Historique:
entrez:
29
5
2021
pubmed:
30
5
2021
medline:
5
6
2021
Statut:
epublish
Résumé
Acute tubulointerstitial nephritis (TIN) is a significant cause of acute renal failure in paediatric and adult patients. There are no large paediatric series focusing on the aetiology, treatment and courses of acute TIN. We collected retrospective clinical data from paediatric patients with acute biopsy-proven TIN by means of an online survey. Members of four professional societies were invited to participate. Thirty-nine physicians from 18 countries responded. 171 patients with acute TIN were included (54% female, median age 12 years). The most frequent causes were tubulointerstitial nephritis and uveitis syndrome in 31% and drug-induced TIN in 30% (the majority of these caused by non-steroidal anti-inflammatory drugs). In 28% of patients, no initiating noxae were identified (idiopathic TIN). Median estimated glomerular filtration rate (eGFR) rose significantly from 31 at time of renal biopsy to 86 mL/min/1.73 m Despite different aetiologies, acute paediatric TIN had a favourable outcome overall with 88% of patients showing no or mild impairment of eGFR after 3-6 months. Prospective randomised controlled trials are needed to evaluate the efficacy of glucocorticoid treatment in paediatric patients with acute TIN.
Sections du résumé
BACKGROUND
Acute tubulointerstitial nephritis (TIN) is a significant cause of acute renal failure in paediatric and adult patients. There are no large paediatric series focusing on the aetiology, treatment and courses of acute TIN.
PATIENTS, DESIGN AND SETTING
We collected retrospective clinical data from paediatric patients with acute biopsy-proven TIN by means of an online survey. Members of four professional societies were invited to participate.
RESULTS
Thirty-nine physicians from 18 countries responded. 171 patients with acute TIN were included (54% female, median age 12 years). The most frequent causes were tubulointerstitial nephritis and uveitis syndrome in 31% and drug-induced TIN in 30% (the majority of these caused by non-steroidal anti-inflammatory drugs). In 28% of patients, no initiating noxae were identified (idiopathic TIN). Median estimated glomerular filtration rate (eGFR) rose significantly from 31 at time of renal biopsy to 86 mL/min/1.73 m
CONCLUSIONS
Despite different aetiologies, acute paediatric TIN had a favourable outcome overall with 88% of patients showing no or mild impairment of eGFR after 3-6 months. Prospective randomised controlled trials are needed to evaluate the efficacy of glucocorticoid treatment in paediatric patients with acute TIN.
Identifiants
pubmed: 34049919
pii: bmjopen-2020-047059
doi: 10.1136/bmjopen-2020-047059
pmc: PMC8166597
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e047059Investigateurs
Olivia Boyer
(O)
Kathrin Buder
(K)
İpek Kaplan Bulut
(İK)
Elisabeth Am Cornelissen
(EA)
Maria Del Mar Espino Hernández
(MDME)
Nakysa Hooman
(N)
Markus Kemper
(M)
Julie Maquet
(J)
Fernando Santos
(F)
Ulrike Walden
(U)
Informations de copyright
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
Pediatr Nephrol. 2017 Apr;32(4):577-587
pubmed: 27155873
Am J Med. 1992 Oct;93(4):472-3
pubmed: 1341422
Q J Med. 1983 Spring;52(206):194-211
pubmed: 6604293
Kidney Int. 2001 Aug;60(2):804-17
pubmed: 11473672
Am J Kidney Dis. 2014 Oct;64(4):558-66
pubmed: 24927897
Eur J Rheumatol. 2014 Mar;1(1):21-33
pubmed: 27708867
Pediatr Nephrol. 2011 Feb;26(2):291-9
pubmed: 21120539
Clin Nephrol. 2006 May;65(5):356-60
pubmed: 16724657
J Rheumatol. 2013 Dec;40(12):2083-7
pubmed: 24128782
Kidney Int. 2010 Jun;77(11):956-61
pubmed: 20336051
Nephrol Dial Transplant. 2004 Jun;19(6):1441-6
pubmed: 15004262
Clin J Am Soc Nephrol. 2014 Nov 7;9(11):1996-2005
pubmed: 25035273
Rheumatology (Oxford). 2017 Mar 1;56(3):362-370
pubmed: 27940588
Clin Nephrol. 2000 Sep;54(3):179-90
pubmed: 11020015
Am J Transplant. 2013 Jun;13(6):1474-83
pubmed: 23721552
Pediatr Nephrol. 2012 Jun;27(6):901-9
pubmed: 21947270
Clin Nephrol. 2010 Dec;74(6):446-56
pubmed: 21084048
Nephrol Dial Transplant. 2014 Sep;29(9):1750-7
pubmed: 24711434
Clin Gastroenterol Hepatol. 2006 May;4(5):597-604
pubmed: 16630752
Ren Fail. 2019 Nov;41(1):576-594
pubmed: 31237170
Nat Rev Nephrol. 2010 Aug;6(8):461-70
pubmed: 20517290
Transpl Infect Dis. 2017 Aug;19(4):
pubmed: 28467620
Am J Kidney Dis. 1999 Dec;34(6):1016-21
pubmed: 10585310
Nephrol Dial Transplant. 1990;5(2):94-9
pubmed: 2113219
Curr Opin Ophthalmol. 2009 Nov;20(6):525-31
pubmed: 19752730
Nephrol Dial Transplant. 2013 Jan;28(1):112-5
pubmed: 22759386
Pediatr Nephrol. 1999 Jun;13(5):426-32
pubmed: 10412864
Nephrol Dial Transplant. 2004 Nov;19(11):2778-83
pubmed: 15340098
Am J Med. 1978 Nov;65(5):756-65
pubmed: 707534
Pediatr Nephrol. 2013 Aug;28(8):1253-60
pubmed: 23605375
Ren Fail. 1996 Jan;18(1):97-104
pubmed: 8820506
Clin J Am Soc Nephrol. 2018 Oct 8;13(10):1605-1611
pubmed: 29615394
Clin Nephrol. 2014 Sep;82(3):149-62
pubmed: 25079860
Kidney Int. 2008 Apr;73(8):940-6
pubmed: 18185501
Pediatr Nephrol. 2012 Dec;27(12):2315-7
pubmed: 22829174
Nephrol Dial Transplant. 2004 Jan;19(1):8-11
pubmed: 14671029
Nephrology (Carlton). 2006 Oct;11(5):381-5
pubmed: 17014549
J Am Soc Nephrol. 2009 Mar;20(3):629-37
pubmed: 19158356
Clin Nephrol. 2016 Jun;85(6):358-62
pubmed: 27142200
Surv Ophthalmol. 2001 Nov-Dec;46(3):195-208
pubmed: 11738428
Mod Rheumatol. 2002 Jun;12(2):148-54
pubmed: 24383903
BMJ Case Rep. 2018 Feb 11;2018:
pubmed: 29440240
Pediatr Nephrol. 2005 Dec;20(12):1809-10
pubmed: 16222551
Case Rep Nephrol Dial. 2019 Nov 13;9(3):137-148
pubmed: 31828077
Kidney Int Rep. 2019 Feb 12;4(5):688-697
pubmed: 31080924
Clin J Am Soc Nephrol. 2006 Jul;1(4):718-22
pubmed: 17699278