The degrees of interstitial fibrosis and arteriosclerosis were reported in accordance with the standardized grading proposed by Sethi et al. The nephritic syndrome was defined as oliguria, hematuria with red blood cell casts, subnephrotic proteinuria, and hypertension. Informed consent was obtained from all of the patients.įor determining the variables, the nephrotic syndrome was defined as proteinuria > 3.5 g per day, serum albumin < 2.5 g/dL, and clinical evidence of peripheral edema and hyperlipidemia. The protocol followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. This study was approved by the Institutional Review Board and was conducted in adherence to the Helsinki Declaration. Moreover, a biochemical urine analysis and spot proteinuria analysis were also performed. Peripheral blood samples were obtained for a complete blood count and a basic metabolic panel. An exhaustive physical examination evaluated cutaneous rash and other signs of systemic diseases. The comprehensive clinical evaluation recorded prescribed and over-the-counter medications, as well as the consumption of herbal medication. The study exclusion criteria included pregnancy, acute coronary syndrome, advanced liver disease, rhabdomyolysis, previous glucocorticoid treatment, and sepsis. Therefore, this study aimed to determine classic clinical and biochemical predictors (specifically BCR) associated with histopathologically-confirmed AIN in patients with AKI.įrom June 2018 to June 2019, we prospectively recruited hospitalized patients of both sexes aged 18 years and older and diagnosed them with AKI according to the creatinine criteria established by the Kidney Disease: Improving Global Outcomes guidelines. It is widely accepted that the blood-ureic nitrogen to creatinine ratio (BCR) decreases in renal tubular lesions, but prospectively obtained clinical-histological evidence relating low BCR to AIN is lacking. Despite the many examined biomarkers, the gold standard continues to be percutaneous renal biopsy. Previous studies have evaluated novel biomarkers of AIN by analyzing markers of inflammation, interstitial edema, cellular damage, and tubular lesions however, their clinical utility remains unknown. Eosinophilia is only present in 10% of patients, thus resulting in poor diagnostic performance. The classic triad described for AIN presentation includes fever, dermatosis, and eosinophilia. Additionally, AIN could be a potential origin of chronic kidney disease from unidentified etiology. AIN has become increasingly relevant in acute and critical care settings over the last few years. Interstitial infiltrates predominantly contain lymphocytes and monocytes, but plasma cells, neutrophils, and histiocytes may also be present. AIN histopathology is characterized by interstitial inflammation and tubulitis. This study is the first to prospectively assess the relationship between renal biopsy results and BCR.Īcute interstitial nephritis (AIN) accounts for 13–27% of acute kidney injury (AKI) cases in hospitalized patients and is diagnosed in 13% of kidney biopsies performed for AKI. ConclusionĪ BCR ≤ 12 identifies AIN in patients with AKI. In the multivariable analysis, BCR was the sole variable associated with AIN. Additionally, in diagnosing AIN, BCR had a sensitivity of 76%, a specificity of 81%, a positive predictive value of 81%, a negative predictive value of 76%, and OR of 14 (95% CI = 2.6 to 75.7, p = 0.021). The optimal Youden point for classifying AIN via a receiver operating characteristic (ROC) curve analysis was a BCR ≤ 12 (AUC = 0.73, p = 0.024). There was a correlation between histology and the BUN/creatinine ratio (BCR) (r = -0.57, p = 0.001). Nineteen patients had histological findings consistent with AIN. Diabetes and hypertension were the main comorbidities. The study consisted of 42 patients (with a mean age of 45 years) and equal numbers of male and female patients. Prior to enrollment, each patient was assessed with a complete metabolic panel and a kidney biopsy. Methodsįor our prospective study, we recruited hospitalized patients aged 18 years and older who were diagnosed with AKI based on biochemical criteria. The objective of this study was to identify clinical and biochemical variables in patients with AKI associated with kidney biopsy-confirmed AIN. In hospitalized patients with acute renal injury (AKI), acute tubulointerstitial nephritis (AIN) constitutes one of the leading etiologies.
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