Is Mycophenolate Mofetil a New Treatment Option in Acute Interstitial Nephritis?

Interstitial nephritis was recognized as a separate disease in the last quarter of the 19th century. Charcot, in his Lectures on Bright’s Disease of the Kidneys (1), discussed it at length, indicating that because death occurred at the end of a long period, the early (acute) phase of the disease could be evaluated only in autopsies from patients who died accidentally. From microscopic studies of these cases, he concluded that the acute phase was characterized by infiltration of cells that “depending on the theory adopted, are called leukocytes or embryonic cells” while the tubular epithelium was initially healthy, only to be dilated, damaged, and involved in “fibrillar connective tissue” in later stages of the disease. Nevertheless, it is usually accepted that acute interstitial nephritis (AIN) first was recognized as a distinct entity by Councilman (2), as a postinfectious complication of diphtheria and scarlet fever. Since then, AIN has been reported in a vast number of infectious and systemic diseases, and it has been shown to be caused by an ever-increasing number of drugs, notably antibiotics, nonsteroidal anti-inflammatory agents, analgesics, H2 antagonists, anticonvulsants, and hypouricemic agents. It is a relatively uncommon condition that represents 2 to 3% of all renal biopsies (3–5), but its annual incidence seems to be rising (5). In cases of acute renal failure, the incidence …