Acute interstitial nephritis not responding to corticosteroid therapy
When corticosteroid therapy is initiated for acute interstitial nephritis and the patient develops dependence on ongoing treatment — or shows resistance — with failure to achieve improvement in kidney function, an alternative treatment strategy is required. This protocol addresses that specific clinical situation.
Escalation trigger — previous line did not achieve its goal
Corticosteroid therapy (prednisolone or prednisone) was administered as the initial treatment. The goal of improvement in kidney function was not reached, or ongoing corticosteroid dependence developed. This failure or dependence is the indication for escalation.
Next-line approach (partial overview)
In corticosteroid-dependent or -resistant acute interstitial nephritis, an alternative immunosuppressive approach is indicated… The full structured regimen — including agent selection, sequencing, and monitoring — is available via the protocol below.
References
- DOI: 10.1016/j.ekir.2025.03.050
- However, their routine use as alternatives to corticosteroids in ATIN is not recommended; in corticosteroid-dependent or -resistant cases, mycophenolate mofetil or targeted T-cell therapies such as antithymocyte globulin may significantly alter the disease course.
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