L QUINTO1, L SUKKAR1,2, M GALLAGHER1,2,3
1The University of Sydney Medical School, Sydney, Australia, 2The George Institute for Global Health (UNSW), Sydney, Australia, 3Sydney School of Public Health, The University of Sydney, Sydney, Australia
Aim: To systematically review the literature on the effect of corticosteroids in the treatment of drug-induced acute interstitial nephritis (DI-AIN).
Background: There is a lack of consensus on the effectiveness of corticosteroids in the treatment of DI-AIN.
Methods: We conducted a systematic review of the literature according to Preferred Reporting in Systematic Reviews and Meta-Analysis (PRISMA) guidelines using MEDLINE, EMBASE, CINAHL, Scopus, and Web of Science from inception until November 2017 with predefined search terms. Studies that compared the effects of corticosteroid therapy versus non-corticosteroid therapy in the treatment of DI-AIN were included. Outcomes were change in serum creatinine, adverse drug reactions, need for renal replacement therapy (RRT) and death. The risk of bias was assessed with the Downs and Black scale for non-randomised studies. Due to considerable heterogeneity a meta-analysis was not performed.
Results: There were no randomised controlled trials. Eight retrospective studies met inclusion criteria with 430 patients (300 received and 130 did not receive corticosteroid therapy), median age of 57 (range 29-75) and 58 (22 –76) years respectively. When treatment details were reported, corticosteroids were commenced at 40-60 mg daily in 5 studies and two studies commenced intravenous methylprednisolone 1 mg/kg. Treatment duration ranged from 1.5-12 weeks. Non-corticosteroid therapy was poorly defined across all studies. Four studies showed no difference in serum creatinine between corticosteroid and comparator arms, while 4 studies found a benefit. Adverse drug reactions, need for RRT and deaths were infrequently reported. Risk of bias was high across all domains.
Conclusions: There is limited evidence to support the use of corticosteroids in the treatment of DI-AIN. Given the risks of corticosteroid therapy, well-designed trials should be a priority.
I previously worked as a researcher in psychology before I decided to pursue medicine. I recently graduated from the University of Sydney and am now a junior medical officer in the Illawarra Shoalhaven Local Health District. I am currently working on research projects that include an economic evaluation of haemodialysis vs transplantation, the impact of “difficult” consultations on registrars and this systematic review on the effectiveness of corticosteroids in treating drug-induced acute interstitial nephritis.