Interstitial nephritis medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohsen Basiri M.D.

The mainstay of treatment for tubulointerstitial nephritis is discontinuation of potentially offending agent. The majority of patients due to drug-induced interstitial nephritis, improve spontaneously with supportive care. However, renal function may not return to baseline. In conditions with persisting renal failure it is recommended to obtain a renal biopsy and trial of glucocorticoids therapy for patients with AIN on biopsy.

The mainstay of treatment for tubulointerstitial nephritis is discontinuation of potentially offending agent. Additional treatment measures include:

1. Supportive care:
   1. Adequate hydration
   2. Symptomatic management for fever, rash, and systemic symptoms.
2. Control of blood pressure with anti-hypertensives.
3. Correction of electrolyte imbalances

• No additional measures are recommend for patients who responded to supportive measures

• In conditions with persisting renal failure it is recommended to obtain a renal biopsy and trial of glucocorticoids therapy for patients with AIN on biopsy..^[1][2]
  • Preferred regimen (1): Prednisone 1 mg/kg per day PO or equivalent IV dose (maximum of 40 to 60 mg)
    • Note: Recommended for 1-2 weeks, followed by gradual tappering.^[3]
  • Alternative regimen (1): Mycophenolate mofetil^[4]
    • Note: Indicated in glucocorticoid resistant or contraindicated cases.

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