Figure 1.

Algorithm for management of drug-induced acute interstitial nephritis. *In patients where kidney biopsy cannot be performed, the decision to start a trial of empirical steroids can be considered on a patient-by-patient basis. An ultrasound showing small kidneys usually indicates advanced fibrosis and unlikely benefit from corticosteroid use. Unfortunately, there are currently no tests that can be recommended to replace biopsy to establish DI-AIN diagnosis. AIN, acute interstitial nephritis; AKD, acute kidney disease; AKI, acute kidney injury; DI-AIN, drug-induced acute interstitial nephritis; IF, interstitial fibrosis; WBC, white blood cell.