BACKGROUND: Acute tubulointerstitial nephritis (TIN) is a significant cause of acute renal failure in paediatric and adult patients. There are no large paediatric series focusing on the aetiology, treatment and courses of acute TIN. PATIENTS, DESIGN AND SETTING: We collected retrospective clinical data from paediatric patients with acute biopsy-proven TIN by means of an online survey. Members of four professional societies were invited to participate. RESULTS: Thirty-nine physicians from 18 countries responded. 171 patients with acute TIN were included (54% female, median age 12 years). The most frequent causes were tubulointerstitial nephritis and uveitis syndrome in 31% and drug-induced TIN in 30% (the majority of these caused by non-steroidal anti-inflammatory drugs). In 28% of patients, no initiating noxae were identified (idiopathic TIN). Median estimated glomerular filtration rate (eGFR) rose significantly from 31 at time of renal biopsy to 86 mL/min/1.73 m2 3-6 months later (p<0.001). After 3-6 months, eGFR normalised in 41% of patients (eGFR ≥90 mL/min/1.73 m2), with only 3% having severe or end-stage impairment of renal function (<30 mL/min/1.73 m2). 80% of patients received corticosteroid therapy. Median eGFR after 3-6 months did not differ between steroid-treated and steroid-untreated patients. Other immunosuppressants were used in 18% (n=31) of patients, 21 of whom received mycophenolate mofetil. CONCLUSIONS: Despite different aetiologies, acute paediatric TIN had a favourable outcome overall with 88% of patients showing no or mild impairment of eGFR after 3-6 months. Prospective randomised controlled trials are needed to evaluate the efficacy of glucocorticoid treatment in paediatric patients with acute TIN.

Department of Pediatric Nephrology 2nf Faculty of Medicine University Hospital Motol Charles University Praha Czech Republic

Department of Pediatric Nephrology Aarhus University Hospital Aarhus Denmark

Department of Pediatric Nephrology and Transplantation New Children's Hospital and Helsinki University Hospital Helsinki Finland

Department of Pediatric Nephrology Azienda Ospedaliero Universitaria di Bologna Ospedale S Orsola Malpighi Bologna Italy

Department of Pediatric Nephrology Bambino Gesù Children's Hospital Roma Italy

Department of Pediatric Nephrology Cipto Mangunkusumo Hospital Faculty of Medicine University of Indonesia Central Jakarta Indonesia

Department of Pediatric Nephrology Connecticut Children's Medical Center Hartford Connecticut USA

Department of Pediatric Nephrology Dona Estefânia Hospital Lisboa Portugal

Department of Pediatric Nephrology Dr Behcet Uz Children Hospital Izmir Turkey

Department of Pediatric Nephrology Faculty of Medicine Ege University Izmir Turkey

Department of Pediatric Nephrology Faculty of Medicine Erciyes University Kayseri Turkey

Department of Pediatric Nephrology Faculty of Medicine Hacettepe University Ankara Turkey

Department of Pediatric Nephrology Faculty of Medicine Istanbul University Cerrahpasa Istanbul Turkey

Department of Pediatric Nephrology Faculty of Medicine Marmara University Istanbul Turkey

Department of Pediatric Nephrology Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy

Department of Pediatric Nephrology Karolinska University Hospital Stockholm Sweden

Department of Pediatric Nephrology Meyer Children's Hospital Florence Italy

Department of Pediatric Nephrology MHH Hannover Germany

Department of Pediatric Nephrology Montpellier University Arnaud de Villeneuve Hospital Montpellier France

Department of Pediatric Nephrology Nationwide Children's Hospital Columbus Ohio USA

Department of Pediatric Nephrology Stony Brook Children's Hospital Stony Brook New York USA

Department of Pediatric Nephrology Temple Street Children's University Hospital Dublin Ireland

Department of Pediatric Nephrology University Children's Hospital Ljubljana Slovenia

Department of Pediatric Nephrology University Hospital of Padova Padova Italy

Department of Pediatric Nephrology Veltischev Research and Clinical Institute for Pediatrics of the Pirogov Russian National Research Medical University Moskva Russian Federation

Department of Pediatrics 2 University Hospital Essen Essen Germany

KfH Centre of Pediatric Nephrology Clementine Kinderhospital Frankfurt am Main Germany

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