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SUMMARY AT A GLANCE: Effects of steroids in acute tubulointerstitial nephritis (ATIN) are still controversial. This study shows a greater degree of improvement in renal function in steroid-treated patients with ATIN. Yet no correlation was shown between the degree of renal recovery and delay in starting steroids. ABSTRACT: Background: The use and timing of steroids in the management of acute tubulointerstitial nephritis (ATIN) remains debatable. Most evidence comes from small uncontrolled retrospective studies with variable results. Aim and objective: To determine the incidence and etiology of ATIN in our unit, trends in the use of steroids, and impact of steroid use on renal outcomes. Methods: Patients with a histological diagnosis of ATIN over nine year's period were identified and divided in to steroid treated (StG) and steroid naïve group (SnG). Mean change in eGFR was determined. Results: Forty nine patients had ATIN as their main diagnosis, 67% of cases were drug induced, and proton pump inhibitors were the second commonest implicated drug category. The majority of patients (75%) were treated with steroids. The improvement in eGFR was significantly greater in the StG (3.4±0.4fold) (SnG: 2.0±0.3fold; p0.45), and no difference in eGFR at the time of last follow-up (StG: 33±3; SnG: 32±7, p>0.9, unpaired t-test). Conclusion: StG patients had a greater degree of improvement in their renal function; however there was no correlation between the degree of improvement in eGFR and delay in starting steroids. PPIs were second commonest implicated drug category among drug induced cases. © 2012 The Authors. Nephrology © 2012 Asian Pacific Society of Nephrology.