Aetiology, course and treatment of acute tubulointerstitial nephritis in paediatric patients: A cross-sectional web-based survey

Wente-Schulz, S. and Aksenova, M. and Awan, A. and Ambarsari, C.G. and Becherucci, F. and Emma, F. and Fila, M. and Francisco, T. and Gokce, I. and Gülhan, B. and Hansen, M. and Jahnukainen, T. and Kallash, M. and Kamperis, K. and Mason, S. and Mastrangelo, A. and Mencarelli, F. and Niwinska-Faryna, B. and Riordan, M. and Rus, R.R. and Saygili, S. and Serdaroglu, E. and Taner, S. and Topaloglu, R. and Vidal, E. and Woroniecki, R. and Yel, S. and Zieg, J. and Pape, L. and Boyer, O. and Buder, K. and Bulut, İ.K. and Cornelissen, E.A.M. and del Mar Espino Hernández, M. and Hooman, N. and Kemper, M. and Maquet, J. and Santos, F. and Walden, U. and international TIN study group, The (2021) Aetiology, course and treatment of acute tubulointerstitial nephritis in paediatric patients: A cross-sectional web-based survey. BMJ Open, 11 (5).

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Abstract

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 m2 3-6 months later (p<0.001). After 3-6 months, eGFR normalised in 41 of patients (eGFR �90 mL/ min/1.73 m2), with only 3 having severe or end-stage impairment of renal function (<30 mL/min/1.73 m2). 80 of patients received corticosteroid therapy. Median eGFR after 3-6 months did not differ between steroid-treated and steroid-untreated patients. Other immunosuppressants were used in 18 (n=31) of patients, 21 of whom received mycophenolate mofetil. 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. © 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.

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