Elevation of erythrocyte sedimentation rate and C-reactive protein levels reflects renal interstitial inflammation in dr
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RESEARCH ARTICLE
Open Access
Elevation of erythrocyte sedimentation rate and C-reactive protein levels reflects renal interstitial inflammation in drug-induced acute tubulointerstitial nephritis Xi-zi Zheng1, Yang-hui Gu1,2,3, Tao Su1, Xu-jie Zhou1,2, Jun-wen Huang1,2, Ping-ping Sun1,2, Yan Jia1,2, Da-min Xu1, Su-xia Wang1,2,4, Gang Liu1,2 and Li Yang1,2*
Abstract Background: A renal biopsy is needed to define active inflammatory infiltration and guide therapeutic management in drug-induced acute tubulointerstitial nephritis (D-ATIN). However, factors such as various contraindications, refusal of informed consent and limited technical support may stop the biopsy process. It is thus of great importance to explore approaches that could deduce probable pathologic changes. Methods: A total of 81 biopsy-proven D-ATIN patients were enrolled from a prospective cohort of ATIN patients at Peking University First Hospital. The systemic inflammation score (SIS) was developed based on the CRP and ESR levels at biopsy, and patients were divided into high-SIS, median-SIS, and low-SIS groups. The demographic data, clinicopathologic features, and renal outcomes were compared. Results: The SIS was positively correlated with inflammatory cell infiltration and was inversely correlated with interstitial fibrosis. The number of interstitial inflammatory cells increased significantly with increasing SISs. The proportions of neutrophils and plasma cells were the highest in the high-SIS group compared with the other two groups. Prednisone (30–40 mg/day) was prescribed in all patients. The high-SIS group tended to have more favorable renal restoration than the other two groups. By 12 months postbiopsy, a decreased eGFR (< 60 mL/min/ 1.73 m2) was observed in 66.7% of medium-SIS patients, 32.4% of high-SIS patients, and 30.4% of low-SIS patients. Conclusion: The SIS was positively correlated with active tubulointerstitial inflammation and therefore could help to aid therapeutic decisions in D-ATIN. Keywords: C reactive protein, Erythrocyte sedimentation rate, Interstitial inflammation, Drug-induced acute tubulointerstitial nephritis
* Correspondence: [email protected] 1 Renal Division, Peking University First Hospital, Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing 100034, People’s Republic of China 2 Renal Pathology Center, Peking University Institute of Nephrology, Beijing 100034, People’s Republic of China Full list of author information is available at the end of the article
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