Acute Interstitial Nephritis When Stopping the Offending Agent and Supportive Care Have Not Resolved Kidney Injury

Clinical scenario

This protocol addresses acute interstitial nephritis (ATIN) in patients who have already received initial conservative management — prompt removal of the causative factor combined with supportive care and close follow-up — but have not achieved the expected recovery of kidney function.

Why escalation is needed

The first-line approach of discontinuing potentially offending medications and providing supportive management targeted signs of kidney injury resolution: a rise in urine output and a sustained fall in serum creatinine. When these goals are not met, a further treatment step is indicated.

Next-step approach (partial)

When conservative measures fail to reverse kidney injury, the next step involves a corticosteroid-based treatment course tailored to the clinical context — the full regimen, dosing strategy, and severity-based adjustments are detailed in the protocol.

Treatment goal

Improvement in kidney function.

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References

DOI: 10.1016/j.ekir.2025.03.050

Corticosteroids remain the cornerstone of ATIN treatment, typically initiated with oral prednisolone or prednisone at 60 mg/d or 0.5 to 1 mg/kg/d.
In drug-induced ATIN, treatment duration generally ranges from 7 to 10 days to a maximum of 6 to 8 weeks, with a tailored tapering strategy.
In severe AKI cases, i.v. pulse steroids can be administered, though no significant advantage over oral high-dose regimens has been demonstrated.

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