Very interesting results from last week’s poll, in which the question asked was essentially, “Do you believe that steroids are effective in the treatment of AIN?” The vote was generally split 50-50; that is, about half of individuals felt that removal of the drug and conservative management was the correct decision and about half of individuals felt that some form of steroids should be used.
This topic is interesting to me because I have run into several experienced nephrologists, whose opinion I really respect, who are adamant that steroids SHOULD be used in the treatment of AIN, despite the conflicting data. One of the major difficulties in evaluating this question clinically is the relative lack of randomized controlled trials, as well as the general trend to diagnose AIN based on clinical grounds rather than a confirmatory renal biopsy. Recently, a 2008 retrospective analysis in KI by Gonzalez et al demonstrated a correlation between a delay in steroid treatment for AIN and the final serum creatinine, causing the authors to suggest that if steroids are going to be used, they should be used relatively early in the disease course.
Check out the latest RFN Poll of the Week in the right margin!
I saw an interesting case of salicylate toxicity.. Did not have to dialyze the pt but good to know the management, like why do you give bicarb and when to dialyze.