genitourinary disorders
Tubulointerstitial Nephritis
Treatment of Tubulointerstitial Nephritis
Treatment of cause (eg, stopping the causative medication) Corticosteroids for immune-mediated and sometimes medication-induced acute tubulointerstitial nephritis Treatment of both ATIN and CTIN is management of the cause. For immunologically induced ATIN and sometimes medication-induced ATIN, corticosteroids (eg,prednisone1 mg/kg orally once/day with gradual tapering of the dose over 4 to 6 weeks) may accelerate recovery. For medication-induced ATIN, corticosteroids are most effective when given within 2 weeks of stopping the causative medications. NSAID-induced ATIN is less responsive to corticosteroids than other medication-induced ATIN. ATIN should be proven by biopsy before corticosteroids are started. Treatment of chronic tubulointerstitial nephritis often requires supportive measures such as controlling blood pressure and treating anemia associated with kidney disease. In patients with CTIN and progressive renal injury, angiotensin-converting enzyme (ACE) inhibitors orangiotensin IIreceptor blockers (ARBs) may slow disease progression but should not be used together because of an additive risk of hyperkalemia and accelerating disease progression. In patients with chronic tubulointerstitial nephritis, angiotensin-converting enzyme (ACE) inhibitors andangiotensin IIreceptor blockers (ARBs) should not be used together because of the additive risk of hyperkalemia and acceleration of disease progression. 