Drug-induced tubulointerstitial nephritis
Tubulointerstitial nephritis (TIN) is characterized by renal failure associated with an array of histologic lesions relating to an infiltration of inflammatory cells in the kidney interstitium with edema, often accompanied by tubulitis. Drug-induced TIN accounts for 3-15% of renal biopsy samples. The presumptive diagnosis is often challenging, given the heterogeneous clinical picture. TIN is typically characterized by a (sub)acute rise in creatininemia, seldom specific.6 Besides, there is often no abnormality in the urinalysis. Therefore, anamnesis is pivotal to the early diagnosis. Etiological investigations should rely on a thorough knowledge of the most suspect drugs, to promptly discontinue the possible culprit. Furthermore, early treatment with steroids may speed renal recovery.

Among 15,696 reports, 12,481 (79.5%) were deemed serious, including 977 (6.2%) fatal cases. The median time to onset was 20 (interquartile range: 5-103) days. The MedDRA terms most frequently co-reported were acute kidney injury, in 6,350 (40.5%) reports, and chronic kidney disease, in 4,292 (27.3%) cases. Pyrexia (512 reports, 3.3%), nausea (391 reports, 2.5%), rash (375 reports, 2.4%) and eosinophilia (320 reports, 2.0%) were the most frequently co-reported extrarenal terms. Among 8,221 cases with an available outcome, TIN completely recovered in 3,019 (36.7%) reports, did not recover in 2,676 (32.6%) reports, and was recovering or recovered with sequelae (without returning to baseline kidney function) in 2,526 (30.7%) reports.

Most of the reported drugs belong to the “alimentary tract and metabolism” and the “antiinfectives for systemic use” categories (Anatomical Therapeutic Chemical classification system), with 8,204 (52.3%) and 4,525 (28.8%) notifications respectively. Specifically, Proton Pump Inhibitors (PPI) were the most frequently reported drugs, with 5,769 (36.8%) reports. Omeprazole was the most reported (4,328, 27.6%), followed by lansoprazole and esomeprazole. Aside from PPIs, the most reported active ingredient was ciprofloxacin with 529 (3.4%) reports, followed by ibuprofen (497, 3.2%), vancomycin (430, 2.7%), diclofenac (299, 1.9%), and sulfamethoxazole/trimethoprim (292, 1.9%). As a whole, beta-lactams accounted for 1,461 reports.

Source: https://www.kireports.org/article/S2468-0249(22)01368-7/fulltext?rss=yes