A predicting tool for kidney function recovery after drug-induced acute interstitial nephritis

被引：0

作者：

Caravaca-Fontan, Fernando ^{[1
]}

Alonso-Riano, Marina ^{[2
]}

Shabaka, Amir ^{[3
]}

Villacorta, Javier ^{[4
]}

de Lorenzo, Alberto ^{[5
]}

Quintana, Luis F. ^{[6
]}

Rodriguez, Eva ^{[7
]}

Gadola, Liliana ^{[8
]}

Cobo, Maria angeles ^{[9
]}

Oliet, Aniana ^{[10
]}

Sierra-Carpio, Milagros ^{[11
]}

Cobelo, Carmen ^{[12
]}

Iglesias, Elena ^{[13
]}

Cordon, Alfredo ^{[14
]}

Praga, Manuel ^{[15
]}

Fernandez-Juarez, Gema ^{[3
]}

Spanish Grp Study Glomerular Dis GLOSEN

机构：

[1] Inst Invest Hosp 12 Octubre imas12, Dept Nephrol, Madrid, Spain

[2] Hosp Univ 12 Octubre, Dept Pathol, Madrid, Spain

[3] Hosp Univ La Paz, Dept Nephrol, Madrid, Spain

[4] Hosp Univ Ramon & Cajal, Dept Nephrol, Madrid, Spain

[5] Hosp Univ Getafe, Dept Pathol, Getafe, Spain

[6] Univ Barcelona, Hosp Clin Barcelona, Dept Nephrol, IDIBAPS, Barcelona, Spain

[7] Hosp Mar, Dept Nephrol, Barcelona, Spain

[8] Univ Republica, Hosp Clin, Dept Nephrol, Montevideo, Uruguay

[9] Hosp Univ Gen Canarias, Dept Nephrol, Tenerife, Spain

[10] Hosp Severo Ochoa, Dept Nephrol, Madrid, Spain

[11] Hosp San Pedro, Dept Nephrol, Logrono, Spain

[12] Hosp Univ Lugus Ausguti, Dept Nephrol, Lugo, Spain

[13] Complejo Hosp Univ Orense, Dept Nephrol, Orense, Spain

[14] Hosp Univ Fdn Alcorcon, Dept Nephrol, Madrid, Spain

[15] Univ Complutense Madrid, Dept Med, Madrid, Spain

来源：

NEPHROLOGY DIALYSIS TRANSPLANTATION | 2025年

关键词：

acute interstitial nephritis; drug-induced; interstitial fibrosis; nomogram; recovery kidney function; CORTICOSTEROIDS; OUTCOMES;

D O I：

10.1093/ndt/gfaf037

中图分类号：

R3 [基础医学]; R4 [临床医学];

学科分类号：

1001 ; 1002 ; 100602 ;

摘要：

Background Drug-induced acute interstitial nephritis (DI-AIN) represents a common cause of acute kidney injury. Early withdrawal of the culprit drug and corticosteroid therapy remains the mainstay of treatment. This study aimed to develop and validate a predictive nomogram to assess the probability of recovery of kidney function at 6 months after treatment. Methods A multicenter, retrospective, observational study was conducted in 13 nephrology departments. Patients with biopsy proven DI-AIN treated with corticosteroids between 1996 and 2023 were included. The dataset was randomly divided into training (n = 164) and validation (n = 60) sets. Least absolute shrinkage and selection operator regression was used to screen the main predictors of complete (creatinine increase <25% of the last value before DI-AIN) or no recovery of kidney function (serum creatinine >= 75% or need for dialysis). Results The study group comprised 224 patients with DI-AIN: 51 (31%) in the training group and 19 (32%) in the validation set achieved complete recovery at 6 months. Conversely, 33 (20%) and 8 (13%) patients in the two sets showed no recovery at 6 months. Clinical characteristics were well balanced between training and validation sets. The selected variables were age (under/above 65 years), gender, degree of interstitial fibrosis and time to corticosteroid initiation (under/above 7 days). Based on a multivariable logistic regression model, a nomogram was developed. The area under the curve of the nomogram was 0.79 (95% confidence interval 0.71-0.88), indicating good discriminative power. Bootstrap self-sampling was performed 1000 times for validation of the model. A calibration plot revealed that the predicted outcomes aligned well with the observations. Decision curve analysis suggested that the model had clinical benefit. Conclusions We developed and validated a nomogram to predict kidney recovery at 6 months in DI-AIN patients treated with corticosteroids. This tool helps clinicians estimate prognosis and optimize corticosteroid therapy's intensity and duration for better treatment outcomes.

引用

页数：10