Effectiveness of corticosteroid compared with non-corticosteroid therapy for the treatment of drug-induced acute interstitial nephritis: a systematic review

Corticosteroids may hasten recovery in drug-induced acute interstitial nephritis (DI-AIN). However, there is no consensus regarding the effectiveness of corticosteroid compared with non-corticosteroid therapy. We conducted a systematic review of the literature according to Preferred Reporting in Systematic Reviews and Meta-Analysis (PRISMA) guidelines using MEDLINE, EMBASE, CINAHL, Scopus and Web of Science from inception until November 2017 using predefined search terms. Studies that compared the effects of corticosteroid therapy versus non-corticosteroid therapy in the treatment of DI-AIN were included. Outcomes were change in serum creatinine, adverse drug reactions, need for renal replacement therapy (RRT) and death. Due to considerable heterogeneity, a meta-analysis was not performed. There were no randomised controlled trials. Eight retrospective studies met inclusion criteria, with 430 patients (300 received and 130 did not receive corticosteroid therapy) and a median age of 57 (range 29-75) and 58 (22-76) years respectively. When treatment details were reported, prednisone was commenced at 40-60 mg daily in five studies, and two studies commenced intravenous methylprednisolone 1 mg/kg with a treatment duration of 1.5-12 weeks. Non-corticosteroid therapy was poorly defined across all studies. Four studies showed no difference in serum creatinine between corticosteroid and comparator arms, while four studies found a benefit. Adverse drug reactions, need for RRT and deaths were infrequently reported. Risk of bias was high across all domains. The limited evidence does not support the use of corticosteroids in the treatment of DI-AIN. Larger, well-designed trials are needed to help guide clinical management of this condition.