Acute interstitial nephritis in the elderly: a report from the UK MRC ...

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Nephrol Dial Transplant (1998) 13 [Suppl 7]: 12–16

Nephrology Dialysis Transplantation

Acute interstitial nephritis in the elderly: a report from the UK MRC Glomerulonephritis Register and a review of the literature A. M. Davison and C. H. Jones Department of Renal Medicine, St James’s University Hospital, Leeds LS9 7TF, UK

Introduction Acute interstitial nephritis is an uncommon renal disorder, causing 2–3% of episodes of acute renal failure [1,2]. There are no specific clinical features, and a high index of suspicion together with a readiness to perform renal biopsy in all cases of unexplained renal failure is required to confirm the diagnosis. Identification of interstitial nephritis is not trivial, as prompt recognition and removal of the precipitating cause usually leads to complete recovery of renal function. Interstitial nephritis may occur at any age, but may be more frequent in the elderly [3]. This could reflect an increased exposure to aetiological agents, an increased susceptibility to interstitial nephritis or a greater sensitivity of ageing kidneys, with already diminished function. To investigate the incidence and clinical features of this disorder in the elderly, we have undertaken a review of all cases of interstitial nephritis from the UK MRC Glomerulonephritis (GN ) Register [4].

Method The MRC GN Register was established in 1978 and included data on unselected renal biopsies by 21 UK centres (see Appendix). The data collected included clinical information (clinical presentation, known duration of renal disease, other associated diseases, details of drug therapy and history of familial renal disease), laboratory data (urine analysis, protein excretion, serum creatinine, serum albumin and serum immunology) and pathological data (histological diagnosis) [4]. All adult cases (age 16) of interstitial nephritis within the MRC GN Register were identified. Patients were defined as having ‘isolated’ or ‘associated’ interstitial nephritis depending on the presence or absence of other clinical or pathological evidence of glomerular or systemic disease. The frequency of clinical features was determined and compared according to age (