Kodner Charles M, Kudrimoti Archana
Department of Family and Community Medicine, University of Louisville School of Medicine, Louisville, Kentucky 40202, USA.
Am Fam Physician. 2003 Jun 15;67(12):2527-34.
Acute interstitial nephritis is an important cause of acute renal failure resulting from immune-mediated tubulointerstitial injury, initiated by medications, infection, and other causes. Acute interstitial nephritis may be implicated in up to 15 percent of patients hospitalized for acute renal failure. Clinical features are essentially those of acute renal failure from any cause, and apart from a history of new illness or medication exposure, there are no specific history, physical examination, or laboratory findings that distinguish acute interstitial nephritis from other causes of acute renal failure. Classic findings of fever, rash, and arthralgias may be absent in up to two thirds of patients. Diagnostic studies such as urine eosinophils and renal gallium 67 scanning provide suggestive evidence, but they are unable to reliably confirm or exclude the diagnosis of acute interstitial nephritis. Renal biopsy remains the gold standard for diagnosis, but it may not be required in mild cases or when clinical improvement is rapid after removal of an offending agent or medication. The time until removal of such agents, and renal biopsy findings, provide the best prognostic information for return to baseline renal function. Corticosteroids appear to provide some benefit in terms of clinical improvement and return of renal function, but no controlled clinical trials have been conducted to confirm this.
急性间质性肾炎是免疫介导的肾小管间质损伤导致急性肾衰竭的重要原因，其发病由药物、感染及其他因素引发。因急性肾衰竭住院的患者中，高达15%可能与急性间质性肾炎有关。临床特征本质上是任何原因导致的急性肾衰竭的特征，除了新发病或用药史外，没有特定的病史、体格检查或实验室检查结果能将急性间质性肾炎与其他急性肾衰竭病因区分开来。高达三分之二的患者可能没有发热、皮疹和关节痛等典型表现。尿嗜酸性粒细胞和肾脏镓67扫描等诊断性检查可提供提示性证据，但无法可靠地确诊或排除急性间质性肾炎。肾活检仍是诊断的金标准，但在轻症病例或停用致病因素或药物后临床迅速改善时，可能无需进行肾活检。清除此类因素的时间以及肾活检结果，为恢复至基线肾功能提供了最佳的预后信息。皮质类固醇似乎在临床改善和肾功能恢复方面有一定益处，但尚无对照临床试验予以证实。
