NSAIDs, Dehydration and Acute Kidney Failure in the Young Adults: An Unrecognized Entity?

Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most widely used drug classes worldwide. As a side effect of the therapy can occur an acute interstitial nephritis (AIN) or an acute tubular necrosis (ATN). In acute kidney injury, a major challenge is to distinguish between underlying etiologies. For instance, there are no disease-specific therapies for acute tubular necrosis, whereas acute interstitial nephritis requires immunosuppressive therapy. The differentiation of the two diseases is very important, but unfortunately, they present clinically and laboratory similarly. Good biomarker for differential diagnosis is lacking. Often renal biopsy is required for diagnosis. Renal biopsy is often associated with side effects and cannot be performed in all patients. Therefore, it is very important to know the small differences of the two diseases. Enclosed we present three typical cases in which we diagnosed ATN based on the clinic, history, and laboratory findings.