Clinical Manifestations and Outcomes of Fluoroquinolone-Related Acute Interstitial Nephritis

Saira Farid, Maryam Mahmood, Omar M. Abu Saleh, Abdurrahman Hamadah, Samih H. Nasr, Zerelda Esquer Garrigos, Nelson Leung, M. Rizwan Sohail

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Abstract

Objective: To describe the clinical presentation, diagnosis, and outcomes of patients with biopsy-proven acute interstitial nephritis (AIN) related to fluoroquinolone (FQ) therapy. Patient and Methods: We conducted a retrospective review of biopsy-proven AIN attributed to FQ use at Mayo Clinic's campus in Rochester, Minnesota, from January 1, 1993, through December 31, 2016. Cases were reviewed by a renal pathologist and attributed to FQ use by an expert nephrologist. We also reviewed and summarized all published case reports of biopsy-proven AIN that were attributed to FQ use. Results: We identified 24 patients with FQ-related biopsy-proven AIN at our institution. The most commonly prescribed FQ was ciprofloxacin in 17 patients (71%), and the median antibiotic treatment duration was 7 days (interquartile range [IQR], 5-12 days). The median time from the initiation of FQ to the diagnosis of AIN was 8.5 days (IQR, 3.75-20.75 days). Common clinical manifestations included fever (12; 50%), skin rash (5; 21%), and flank pain (2; 8%), and 9 (38%) had peripheral eosinophilia. However, 4 (17%) of the patients were asymptomatic at the time of diagnosis and AIN was suspected on the basis of routine laboratory monitoring. Most patients (17; 71%) recovered after the discontinuation of antibiotic therapy, and renal function returned to baseline at a median of 20.5 days (IQR, 11.75-27.25 days). Six patients (25%) required temporary hemodialysis, and 14 patients (58%) received corticosteroid therapy. Conclusion: The onset of FQ-related AIN can be delayed, and a high index of suspicion is needed by physicians evaluating these patients. Overall outcomes are favorable, with recovery to baseline renal function within 3 weeks of discontinuing the offending drug.

Original languageEnglish (US)
JournalMayo Clinic Proceedings
DOIs
StateAccepted/In press - Jan 1 2017

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Interstitial Nephritis
Fluoroquinolones
Biopsy
Kidney
Anti-Bacterial Agents
Flank Pain
Eosinophilia
Therapeutics
Ciprofloxacin
Exanthema
Renal Dialysis
Adrenal Cortex Hormones
Fever
Physicians

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Farid, S., Mahmood, M., Abu Saleh, O. M., Hamadah, A., Nasr, S. H., Garrigos, Z. E., ... Sohail, M. R. (Accepted/In press). Clinical Manifestations and Outcomes of Fluoroquinolone-Related Acute Interstitial Nephritis. Mayo Clinic Proceedings. https://doi.org/10.1016/j.mayocp.2017.08.024

Clinical Manifestations and Outcomes of Fluoroquinolone-Related Acute Interstitial Nephritis. / Farid, Saira; Mahmood, Maryam; Abu Saleh, Omar M.; Hamadah, Abdurrahman; Nasr, Samih H.; Garrigos, Zerelda Esquer; Leung, Nelson; Sohail, M. Rizwan.

In: Mayo Clinic Proceedings, 01.01.2017.

Research output: Contribution to journalArticle

Farid, S, Mahmood, M, Abu Saleh, OM, Hamadah, A, Nasr, SH, Garrigos, ZE, Leung, N & Sohail, MR 2017, 'Clinical Manifestations and Outcomes of Fluoroquinolone-Related Acute Interstitial Nephritis', Mayo Clinic Proceedings. https://doi.org/10.1016/j.mayocp.2017.08.024
Farid, Saira ; Mahmood, Maryam ; Abu Saleh, Omar M. ; Hamadah, Abdurrahman ; Nasr, Samih H. ; Garrigos, Zerelda Esquer ; Leung, Nelson ; Sohail, M. Rizwan. / Clinical Manifestations and Outcomes of Fluoroquinolone-Related Acute Interstitial Nephritis. In: Mayo Clinic Proceedings. 2017.
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abstract = "Objective: To describe the clinical presentation, diagnosis, and outcomes of patients with biopsy-proven acute interstitial nephritis (AIN) related to fluoroquinolone (FQ) therapy. Patient and Methods: We conducted a retrospective review of biopsy-proven AIN attributed to FQ use at Mayo Clinic's campus in Rochester, Minnesota, from January 1, 1993, through December 31, 2016. Cases were reviewed by a renal pathologist and attributed to FQ use by an expert nephrologist. We also reviewed and summarized all published case reports of biopsy-proven AIN that were attributed to FQ use. Results: We identified 24 patients with FQ-related biopsy-proven AIN at our institution. The most commonly prescribed FQ was ciprofloxacin in 17 patients (71{\%}), and the median antibiotic treatment duration was 7 days (interquartile range [IQR], 5-12 days). The median time from the initiation of FQ to the diagnosis of AIN was 8.5 days (IQR, 3.75-20.75 days). Common clinical manifestations included fever (12; 50{\%}), skin rash (5; 21{\%}), and flank pain (2; 8{\%}), and 9 (38{\%}) had peripheral eosinophilia. However, 4 (17{\%}) of the patients were asymptomatic at the time of diagnosis and AIN was suspected on the basis of routine laboratory monitoring. Most patients (17; 71{\%}) recovered after the discontinuation of antibiotic therapy, and renal function returned to baseline at a median of 20.5 days (IQR, 11.75-27.25 days). Six patients (25{\%}) required temporary hemodialysis, and 14 patients (58{\%}) received corticosteroid therapy. Conclusion: The onset of FQ-related AIN can be delayed, and a high index of suspicion is needed by physicians evaluating these patients. Overall outcomes are favorable, with recovery to baseline renal function within 3 weeks of discontinuing the offending drug.",
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AB - Objective: To describe the clinical presentation, diagnosis, and outcomes of patients with biopsy-proven acute interstitial nephritis (AIN) related to fluoroquinolone (FQ) therapy. Patient and Methods: We conducted a retrospective review of biopsy-proven AIN attributed to FQ use at Mayo Clinic's campus in Rochester, Minnesota, from January 1, 1993, through December 31, 2016. Cases were reviewed by a renal pathologist and attributed to FQ use by an expert nephrologist. We also reviewed and summarized all published case reports of biopsy-proven AIN that were attributed to FQ use. Results: We identified 24 patients with FQ-related biopsy-proven AIN at our institution. The most commonly prescribed FQ was ciprofloxacin in 17 patients (71%), and the median antibiotic treatment duration was 7 days (interquartile range [IQR], 5-12 days). The median time from the initiation of FQ to the diagnosis of AIN was 8.5 days (IQR, 3.75-20.75 days). Common clinical manifestations included fever (12; 50%), skin rash (5; 21%), and flank pain (2; 8%), and 9 (38%) had peripheral eosinophilia. However, 4 (17%) of the patients were asymptomatic at the time of diagnosis and AIN was suspected on the basis of routine laboratory monitoring. Most patients (17; 71%) recovered after the discontinuation of antibiotic therapy, and renal function returned to baseline at a median of 20.5 days (IQR, 11.75-27.25 days). Six patients (25%) required temporary hemodialysis, and 14 patients (58%) received corticosteroid therapy. Conclusion: The onset of FQ-related AIN can be delayed, and a high index of suspicion is needed by physicians evaluating these patients. Overall outcomes are favorable, with recovery to baseline renal function within 3 weeks of discontinuing the offending drug.

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