Li X, Yang L, Yu Y
Renal Division of Peking University First Hospital, Beijing 100034, China.
Zhonghua Nei Ke Za Zhi. 2001 Oct;40(10):681-7.
To investigate the clinical and pathological characteristics of Mutong (a Chinese herb, caulis aristolochiae manshuriensis) induced tubulointerstitial nephropathy (MT-TIN), and analyze the related to renal function decline and clinical prognosis.
51 patients with MT-TIN were studied retrospectively. They were divided into acute, mild chronic and severe chronic groups according to the pathological lesion. Clinical and pathological data were semi-quantitatively assessed. Correlation and regression of the parameters were further tested. Relationship between medication and the illness, incidence, clinical characteristics, therapy and regression of the disease were analyzed. The results of the acute group of MT-TIN were compared with those of the antibiotics-induced acute tubular necrosis (A-ATN) and acute interstitial nephritis (A-AIN).
The common clinical symptoms of MT-TIN were fatigue, polyuria, nocturia, usually accompanied by renal tubular dysfunction with or without an elevated serum creatinine (Scr) level. It was rare to find urine abnormality and anemia in the acute and mild chronic groups. The pathological examination of MT-TIN revealed that there were severe degradation, necrosis and collapse of the renal epithelial cells leaving the basement membrane naked. Regeneration was rarely seen as in A-ATN. Cellular infiltrate in the interstitium was also rarely seen as in A-AIN. However, marked tubular atrophy and early occurrence of diffuse interstitial fibrosis were detected in the chronic groups. Correlation and regression tests showed that the level of Scr correlates obviously with the degree of anemia and renal interstitial fibrosis. After withdrawal of medication containing MT, most patients' Scr level became steady within 2 months. Both the clinical and pathological characteristics were different with those of A-ATN or A-AIN. Most of the patients suffering from MT-TIN got the disease by over-dose or long-term taking of medicines containing Mu-Tong. Few patients had it when taking regular dose of the medicine.
MT-TIN is a special type of drug-induced tubulointerstitial nephropathy, which is mainly related to over-dose or long-term taking of Mu-Tong, which contains aristolochic acid. One should try to avoid using Mu-Tong containing aristolochic acid and pay attention to monitor the renal function if the medication has to be given.
探讨木通（一种中药，东北马兜铃茎）所致肾小管间质性肾病（MT-TIN）的临床及病理特征，并分析其与肾功能减退及临床预后的关系。
对51例MT-TIN患者进行回顾性研究。根据病理损害将其分为急性、轻度慢性和重度慢性组。对临床和病理资料进行半定量评估。进一步检测参数的相关性和回归情况。分析用药与疾病的关系、发病率、临床特征、治疗及疾病转归。将MT-TIN急性组的结果与抗生素所致急性肾小管坏死（A-ATN）和急性间质性肾炎（A-AIN）的结果进行比较。
MT-TIN的常见临床症状为乏力、多尿、夜尿，通常伴有肾小管功能障碍，血清肌酐（Scr）水平可升高或不升高。急性组和轻度慢性组很少出现尿异常和贫血。MT-TIN的病理检查显示肾上皮细胞严重退变、坏死和崩解，基底膜裸露。再生情况少见，不像A-ATN。间质细胞浸润也少见，不像A-AIN。然而，慢性组可见明显的肾小管萎缩和早期弥漫性间质纤维化。相关性和回归分析表明，Scr水平与贫血程度和肾间质纤维化程度明显相关。停用含木通的药物后，大多数患者的Scr水平在2个月内趋于稳定。其临床和病理特征与A-ATN或A-AIN不同。大多数MT-TIN患者是因过量或长期服用含木通的药物患病。服用常规剂量药物的患者很少患病。
MT-TIN是一种特殊类型的药物性肾小管间质性肾病，主要与过量或长期服用含马兜铃酸的木通有关。应尽量避免使用含马兜铃酸的木通，如需用药应注意监测肾功能。
