INTRODUCTION: Acute tubulointerstitial nephritis (ATIN) is a well-recognized cause of acute kidney injury (AKI) due to the tubulointerstitial inflammation. The aim of this study was to explore the clinical features, outcomes, and responses to corticosteroid treatment in patients with ATIN. METHODS: Patients with biopsy-proven ATIN, who were diagnosed between 1994 and 2016 at the Department of Nephrology, Charles University, First Faculty of Medicine, and General University Hospital in Prague, were included in the study. Patient demographics, the aetiological and clinical features, the treatment given, and the outcome at 1 year of follow-up were extracted from patient records. RESULTS: A total of 103 ATIN patients were analysed, of which 68 had been treated with corticosteroids. There was no significant difference in the median serum creatinine 280 (169-569) μmol/L in the conservatively managed group versus 374 (249-558) μmol/L in the corticosteroid-treated group, p = 0.18, and dependence on dialysis treatment at baseline at the time of biopsy (10.3 vs. 8.6%). During the 1 year of follow-up, those ATIN patients who had been treated with corticosteroids did better and showed greater improvement in kidney function, determined as serum creatinine difference from baseline and from 1 month over 1-year period (p = 0.001). CONCLUSIONS: This single-centre retrospective cohort study supports the beneficial role of the administration of corticosteroid therapy in the management of ATIN.
- MeSH
- dialýza ledvin * škodlivé účinky MeSH
- hormony kůry nadledvin terapeutické užití MeSH
- intersticiální nefritida * farmakoterapie diagnóza MeSH
- kreatinin MeSH
- ledviny patologie MeSH
- lidé MeSH
- retrospektivní studie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
[This corrects the article DOI: 10.3389/ti.2023.11590.].
- Publikační typ
- tisková chyba MeSH
[This corrects the article DOI: 10.3389/ti.2023.11589.].
- Publikační typ
- tisková chyba MeSH
The Thrombotic Microangiopathy Banff Working Group (TMA-BWG) was formed in 2015 to survey current practices and develop minimum diagnostic criteria (MDC) for renal transplant TMA (Tx-TMA). To generate consensus among pathologists and nephrologists, the TMA BWG designed a 3-Phase study. Phase I of the study is presented here. Using the Delphi methodology, 23 panelists with >3 years of diagnostic experience with Tx-TMA pathology listed their MDC suggesting light, immunofluorescence, and electron microscopy lesions, clinical and laboratory information, and differential diagnoses. Nine rounds (R) of consensus resulted in MDC validated during two Rs using online evaluation of whole slide digital images of 37 biopsies (28 TMA, 9 non-TMA). Starting with 338 criteria the process resulted in 24 criteria and 8 differential diagnoses including 18 pathologic, 2 clinical, and 4 laboratory criteria. Results show that 3/4 of the panelists agreed on the diagnosis of 3/4 of cases. The process also allowed definition refinement for 4 light and 4 electron microscopy lesions. For the first time in Banff classification, the Delphi methodology was used to generate consensus. The study shows that Delphi is a democratic and cost-effective method allowing rapid consensus generation among numerous physicians dealing with large number of criteria in transplantation.
- MeSH
- analýza nákladů a výnosů MeSH
- biopsie MeSH
- konsensus MeSH
- lidé MeSH
- transplantace ledvin * MeSH
- trombotické mikroangiopatie * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
The Banff community summoned the TMA Banff Working Group to develop minimum diagnostic criteria (MDC) and recommendations for renal transplant TMA (Tx-TMA) diagnosis, which currently lacks standardized criteria. Using the Delphi method for consensus generation, 23 nephropathologists (panelists) with >3 years of diagnostic experience with Tx-TMA were asked to list light, immunofluorescence, and electron microscopic, clinical and laboratory criteria and differential diagnoses for Tx-TMA. Delphi was modified to include 2 validations rounds with histological evaluation of whole slide images of 37 transplant biopsies (28 TMA and 9 non-TMA). Starting with 338 criteria in R1, MDC were narrowed down to 24 in R8 generating 18 pathological, 2 clinical, 4 laboratory criteria, and 8 differential diagnoses. The panelists reached a good level of agreement (70%) on 76% of the validated cases. For the first time in Banff classification, Delphi was used to reach consensus on MDC for Tx-TMA. Phase I of the study (pathology phase) will be used as a model for Phase II (nephrology phase) for consensus regarding clinical and laboratory criteria. Eventually in Phase III (consensus of the consensus groups) and the final MDC for Tx-TMA will be reported to the transplantation community.
- MeSH
- alografty MeSH
- aminy MeSH
- antikoagulancia MeSH
- konsensus MeSH
- ledviny MeSH
- lidé MeSH
- transplantace ledvin * škodlivé účinky MeSH
- trombotické mikroangiopatie * diagnóza etiologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Náhle vzniklé akutní selhání ledvin u pacientů ve vyšším věku může být způsobeno širokým spektrem chorob, které mají obvykle příčinu mimo ledviny. Mezi nejčastější patří postižení ledvin jako součást ANCA vaskulitid, další kategorie zahrnuje klonální onemocnění plasmatických buněk s nadprodukcí lehkých řetězců (light chain cast nephropathy, tzv. myelomová ledvina) a také stále narůstající počet polékových poškození tubulointersticia ledvin. Prezentujeme případ iatrogenní, méně obvyklé formy akutního selhání u 73 leté ženy, která do té doby netrpěla žádným závažným onemocněním. I když biopsie napomohla určit příčinu selhání a tím ovlivnit následující terapii, funkce ledvin se do předchozího stavu nevrátila a pacientka progredovala do CKD G3bA1 s hodnotami sérového kreatininu kolem 170-140 μmol/l.
Acute renal failure in elderly patients can be caused by a wide spectrum of diseases that usually have a cause outside the kidney. The most common causes include renal impairment as part of ANCA vasculitis, another category includes clonal plasmatic cell disease with light chain cast nephropathy; and there also exists an increasing number of drug-induced tubulointerstial damage. We present a case of iatrogenic less common form of acute failure in a 73-year-old woman, who did not suffer from any serious disease until then. Although the biopsy helped to determine the cause of the failure and thus affect subsequent therapy, the function did not return to the previous state and the patient progressed to CKD G3bA1 with serum creatinine values of around 170-140 μmol/l.
- MeSH
- akutní poškození ledvin * chemicky indukované diagnóza etiologie terapie MeSH
- biopsie metody MeSH
- ledvinové kanálky MeSH
- lidé MeSH
- nežádoucí účinky léčiv MeSH
- rhabdomyolýza * chemicky indukované komplikace MeSH
- sběrací ledvinové kanálky MeSH
- senioři MeSH
- statiny škodlivé účinky toxicita MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- Publikační typ
- abstrakt z konference MeSH
