J Korean Med Sci.  2020 Jul;35(26):e206. 10.3346/jkms.2020.35.e206.

Long-term Renal Outcome of Biopsy-proven Acute Tubular Necrosis and Acute Interstitial Nephritis

• Kim H
• Jo SK
• Ahn SY
• Kwon YJ
• Lee H
• Oh J
• Chin HJ
• Lim K
• Lee J
• Yang J
• Kim MG
• Cho WY
• Oh SW

• KMID: 2503680
• DOI: http://doi.org/10.3346/jkms.2020.35.e206

Abstract

Background
Although emerging evidence suggest acute kidney injury (AKI) progress to chronic kidney disease (CKD), long-term renal outcome of AKI still remains unclear. Acute tubular necrosis (ATN) is the most common cause of AKI due to ischemia, toxin or sepsis. Acute interstitial nephritis (AIN), caused by drugs or autoimmune diseases is also increasingly recognized as an important cause of AKI. Unlike glomerular diseases, AKI is usually diagnosed in the clinical context without kidney biopsies, and lack of histology might contribute to this uncertainty.
Methods
Among 8,769 biopsy series, 253 adults who were histologically diagnosed with ATN and AIN from 1982 to 2018 at five university hospitals were included. Demographic and pathological features that are associated with the development of end stage renal disease (ESRD) were also examined.
Results
Rate of non-recovery of renal function at 6 month was significantly higher in the AIN (ATN vs AIN 49.3 vs 69.4%, P = 0.007) with a 2.71-fold higher risk of non- recovery compared to ATN (95% confidence interval [CI], 1.20–6.47). During the mean follow up of 76.5 ± 91.9 months, ESRD developed in 39.4% of patients with AIN, and 21.5% patients of ATN. The risk of ESRD was significantly higher in AIN (23.05; 95% CI, 2.42–219.53) and also in ATN (12.14; 95% CI, 1.19–24.24) compared to control with non-specific pathology. Older age, female gender, renal function at the time of biopsy and at 6 months, proteinuria and pathological features including interstitial inflammation and fibrosis, tubulitis, vascular lesion were significantly associated with progression to ESRD.
Conclusion
Our study demonstrated that patients with biopsy proven ATN and AIN are at high risk of developing ESRD. AIN showed higher rate of non-renal recovery at 6 month than ATN.

Keyword

Acute Interstitial Nephritis; Acute Tubular Necrosis; Inflammation; Fibrosis

Figure

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  Fig. 1 Inclusion criteria of study patients.ATN = acute tubular necrosis, AIN = acute interstitial nephritis, GN = glomerulonephritis.

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  Fig. 2 Incidence of non-renal recovery at 6 months.The incidence of non-renal recovery was lower in the ATN group than in the AIN group, at 49.3% and 69.4%, respectively, (P = 0.007). Non-renal recovery was defined as estimated glomerular filtration rate < 60 mL/min/1.73 m2 at 6 months.ATN = acute tubular necrosis, AIN = acute interstitial nephritis.

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  Fig. 3 Incidence of end-stage renal disease.Renal survival in the ATN and AIN groups was significantly lower than that in the N-S group (P < 0.001).ATN = acute tubular necrosis, AIN = acute interstitial nephritis.

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