Improvement in renal function after empirical steroid therapy in NSAID-induced acute kidney injury

Abstract

We report a case of an 81-year-old woman, who developed acute kidney injury (AKI) during treatment of gout with naproxen. The patient’s other comorbidities were chronic kidney disease grade G3b, chronic heart failure with permanent atrial fibrillation, arterial hypertension, osteoarthritis and osteoporosis. After excluding other causes of AKI, a presumptive diagnosis of NSAID-induced acute interstitial nephritis was established. Because of multiple comorbidities and anticoagulation, renal biopsy was not attempted. Since we observed no improvement after naproxen discontinuation, steroid-pulse therapy was initiated, with subsequent oral steroid follow-up. As a result, after several days we achieved improvement in renal function, with complete recovery after couple of months. In conclusion, we suggest that aggressive steroid therapy be considered for patients with presumptive diagnosis of NSAID-induced interstitial nephritis, especially when comorbidities and general state preclude invasive diagnostic measures.