Citation Information :
Sharma M, Parry MA, Mahanta PJ, Doley P, Pegu G, Jeelani H. Drug-induced Acute Kidney Injury/Acute Tubulointerstitial Nephritis: A Clinico-etiological Study from a Single Center in North-east India. J Postgrad Med Edu Res 2019; 53 (1):7-10.
Introduction: Drug-induced acute kidney injury (AKI)/acute tubule-interstitial nephritis (ATIN) is an important cause of AKI. There is little information about drug-induced AKI in our part of the world (north-east India).
Aim: To determine the clinico-etiological profile of drug-induced AKI and their outcome in our part of the world and correlation with the histological pattern.
Materials and methods: This is a retrospective observational study of patients who developed AKI following intake of some medications. AKI was defined as per risk’ injury faiure less and end-stage kidney (RIFLE) criteria. On ultrasonography, kidney size was normal without any evidence of obstruction. Kidney biopsy was done in patients who didn't improve or had a history of multiple drugs or unknown drugs. Patients’ clinical data were correlated with offending drug and histopathology findings
Results: A total of 97 patients were included in this study, 60% were males and 40% were females. Mean age of patients was 45 ± 12.09 years. Herbal medication (29%) was the most common cause of drug-induced AKI, followed by nonsteroidal anti-inflammatory drugs (NSAIDs) (26%). Renal biopsy was done in 54 patients, 59.6% had acute tubulointerstitial nephritis (ATIN), 35% of patients had acute on the chronic TIN. Renal replacement therapy was required in 57.7% patients. Full renal recovery occurred in 38% patients while as, partial recovery occurred in 30% patients. Out of 29 patients with herbal medication intake,17% had full recovery compared to 56% in NSAID group.
Conclusion: Drug-induced AKI is an important cause of renal dysfunction and can be under-diagnosed. AKI may occur with many drugs. Herbal medications were the most common cause of drug-induced AKI and had poor renal outcome compared to NSAIDs.
Clinical significance: In our study, herbal medications intake was a common cause of AKI and was associated with poor renal recovery. Early suspicion and withdrawal of the offending drug are needed to prevent renal damage.
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