YALIN YU1, ERIK BIROS3, XIAO CHANG1, ANDREW MALLETT1,2,3,4
1Townsville Institute of Health Research and Innovation, Townsville University Hospital, Townsville , Australia, 2Department of Renal Medicine, Townsville University Hospital, Townsville , Australia , 3College of Medicine and Dentistry, James Cook University, Townsville , Australia , 4Institute for Molecular Bioscience, The University of Queensland, Brisbane , Australia
Biography:
Dr Yalin Yu is a basic physician trainee at Queensland Health with a strong interest in nephrology and clinical research. She recently led a systematic review on the treatment of acute interstitial nephritis, evaluating the role of pharmacotherapy in renal recovery. She is also the lead author of a recently published study on hyperkalaemia in hospital admissions, exploring its impact on patient outcomes and hospital length of stay. She is passionate about integrating research into clinical practice to improve patient care and outcomes.
Aim:
To evaluate the effectiveness and adverse effects of pharmacotherapy treatments for acute interstitial nephritis (AIN).
Background:
AIN is an important cause of acute kidney injury. Management of AIN primarily includes early diagnosis, management of underlying causes, withdrawal of the offending agent, and corticosteroid therapy when appropriate. Evidence supporting pharmacotherapy and the optimal timing, dosage, and duration of treatment is limited.
Methods:
Major databases were systematically searched in June 2024 after PROSPERO registration. Studies focusing on the treatment of histologically diagnosed AIN cases were included. A systematic review and a fixed-effects meta-analysis with meta-regression were performed using Stata SE 16.
Results:
The systematic review included 23 studies: 3 randomised controlled trials, 4 case series and 16 retrospective cohort studies. Corticosteroids were the primary treatment in most studies, with one study examining mycophenolate mofetil in steroid-refractory AIN. 13 studies focused on drug-induced AIN. 8 studies observed positive effect of corticosteroids on renal function, 8 did not, and 5 were inconclusive. Timing of corticosteroid initiation was found to affect renal outcomes in 3 of 7 studies. Corticosteroids were associated with better long-term renal outcomes in 3 of 5 studies. Adverse effects (i.e. infection, diabetes) were reported in 4 studies. Risk of bias was moderate to high. Quality of evidence was very low for all outcomes. A meta-analysis of 3 studies using prednisolone 1mg/kg/day showed significant improvement in serum creatinine (Cohen’s d = -2.24, 95% CI -2.82 to -1.67, p < 0.001, I² = 0%). Meta-regression found no relationship between effect size, age or treatment duration (p = 0.67).
Conclusions:
Strong evidence supporting corticosteroid use in AIN is lacking. Adverse events were likely under-reported.
Presentation Slides PDF – Click Here