Acute interstitial nephritis in patients with inflammatory bowel disease treated with vedolizumab: a systematic review

Figures & data

Table 1. Clinical characteristics of cases included in systematic review of AIN in patients with IBD treated with vedolizumab.

Author, year	Country	IBD	Sex	Age at AIN	Time since start VZB	Cr/eGFR at AIN	Biopsy verified AIN	Treatment AIN	Cr/eGFR after AIN^a	Permanent kidney injury	Rechallenge/successful	Naranjo^b/WHO^c scale
				(years)	(months)	(µmol/L/; ml/min)	(yes/no)		(µmol/L; ml/min)	(yes/no)	(yes/no)
Bailly, 2018	France	CD	F	55	0	410/10	Yes	CS	88/63	No	Yes/yes	Possible/possible
Jahan, 2022	Australia	UC	F	19	2	280	Yes	CS	NA	Yes	No/–	Possible/unlikely
Kepley, 2021	USA	UC	M	33	NA	NA	Yes	CS	NA	Yes	Yes/no	Probable/unlikely^d
Kepley, 2021	USA	UC	F	45	NA	NA	Yes	NA	NA	NA	NA	Possible/unclassified^e
Muzib, 2020	USA	UC	F	58	12	199	Yes	CS	97/58^Table Footnotef	NA	NA	Possible/possible
O’Leary, 2022	Australia	UC	M	21	>6	133	Yes	CS	108/86^Table Footnotef	Yes	Yes/no	Probable/probable
Simpson, 2023	UK	CD	F	44	12	165/29	Yes	CS	130/39	Yes	No/–	Possible/possible
Subhaharan, 2022	Australia	UC	M	20	10	171/49	Yes	CS	89/>90	No	No/–	Possible/probable
Zhang, 2020	USA	CD	F	33	2	177	Yes	CS	150/40^Table Footnotef	Yes	No/–	Possible/possible

AIN, acute tubulointerstitial nephritis; CD, Crohn’s disease; Cr, creatinine; CS, corticosteroids; F, female; IBD, inflammatory bowel disease; M, male; NA, data not available; UC, ulcerative colitis; VZB, vedolizumab.

^aAfter treatment with corticosteroids.

^bAccording to Naranjo scale initially described in Naranjo et al. [19].

^cAccording to WHO-UMC system described in World Health Organization (WHO)-Uppsala Monitoring Centre [18].

^dDue to a later positive rechallenge with aminosalicylates.

^eMore data needed for proper assessment.

^feGFR calculated with the CKD-EPI 2021 equation.

Table 2. Clinical characteristics of cases included in systematic review of AIN in patients with IBD treated with vedolizumab.

Author, year	Dose/dose interval vedolizumab	Aminosalicylates^a	Other concomitant drugs	Symptoms	Biopsy findings	Main laboratory findings
	(mg/w)	(yes/no)
Bailly, 2018	300/NA	No	None	Vomiting, asthenia, fever, myalgia, pyoderma gangrenosum	AIN with interstitial edema, interstitial infiltrate of lymphocytes, plasma cells, histiocytes, granuloma formation.	CRP 130 mg/L, WBC 14.2 × 10^3/µL Eosinophilia, neutrophilia
Jahan, 2022	NA	Yes	None	Calf pain	AIN	NA
Kepley, 2021 (M)	NA	Yes	Budesonide, PPI	Fever and chills	Acute and chronic TIN with severe interstitial fibrosis, tubular atrophy and focal global glomerulosclerosis.	NA
Kepley, 2021 (F)	NA	Yes	Losartan, PPI	NA	Acute and chronic TIN with eosinophils	NA
Muzib, 2020	300/8	No	NA	None	Focal degenerative changes in tubules consistent with mild ATN. AIN with interstitial infiltrates with mononuclear cells and frequent eosinophils	Hematuria and leukocyturia, nitrite negative.
O’Leary, 2022	NA	No	None	Fever, malaise, nausea	AIN with interstitial infiltrate of lymphocytes	NA
Simpson, 2023	300/6	No	Budesonide, calcium + vitamin D	Fever, malaise, myalgia	AIN with interstitial fibrosis and tubular atrophy. Interstitial infiltrate of lymphocytes, plasma cell, macrophages	WBC 14.3 × 10^3/µL Erythro- and leukocyturia.
Subhaharan, 2022	NA/8	No	None	Right flank pain	AIN with interstitial infiltrates of lymphocytes and occasional eosinophils.	CRP 74 mg/L, WBC 103 × 10^3/µL, neutrophilia, Hb 166 g/L, elevated ANCA.
Zhang, 2020	300/8	No	NA	NA	AIN with interstitial infiltrate of lymphocytes with tubulitis.	NA

AIN, acute tubulointerstitial nephritis; ANCA, anti-neutrophil cytoplasmic antibody; ATN, acute tubular necrosis; CD, Crohn’s disease; Cr, creatinine; CRP, C-reactive protein; CS, corticosteroids; F, female; IBD, inflammatory bowel disease; M, male; NA, data not available; PPI; proton pump inhibitor; TIN, tubulointerstitial nephritis; UC, ulcerative colitis; VZB, vedolizumab; WBC, white blood count; W, weeks.

^aConcomittant treatment with any of the following: mesalamine (mesalazine, 5-aminosalicylate), sulfasalazine.

Naranjo CA, Busto U, Sellers EM, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30(2):239–245. doi: 10.1038/clpt.1981.154.

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World Health Organization (WHO)-Uppsala Monitoring Centre. The use of the WHO-UMC system for standardized case causality assessment. Available at http://www.who-umc.org/Graphics/24734.pdf

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