Koarada S, Nagano Y, Sakemi T, Syouno Y, Watanabe T
Department of Intenal Medicine, Saga Medical School, Japan.
Nihon Jinzo Gakkai Shi. 1992 Nov;34(11):1227-32.
Cimetidine is a histamine H2-receptor antagonist. Widely it is prescribed, and then various side effects have been increasingly recognized. Acute renal failure as a result of acute interstitial nephritis is one of the most important adverse effect. We report a case of biopsy-proven acute interstitial nephritis following cimetidine therapy. Farther more, we review other reported cases of cimetidine-induced acute interstitial nephritis, and discuss the clinical features and a role of immunological mechanisms of these cimetidine-induced disorders. A 52-year-old woman was admitted because of fever and protenuria. A month before admission, she developed gastric ulcer and was given cimetidine 600mg orally a day by a near physician. Laboratory data on admission included the following: white blood cell count, 14700/microliters; eosinophils, 6%; BUN, 50.7mg/dl; Cr, 7.6mg/dl; CRP, 34.0mg/dl. All drugs were discontinued because we suspected drug-induced acute renal failure, especially by cimetidine. Renal biopsy performed on day 3 showed interstitial nephritis with lymphocyte infiltration which was composed mainly of T cell. T4/T8 ratio was determined to be 1. There was neither predominance of helper nor cytotoxic cells in T cell subpopulation. We reviewed 22 cases reported and discussed the features of cimetidine-induced interstitial nephritis. The most important thing is to monitor renal function periodically with the suspicion of this disorder. On the detection of abnormality of laboratory data, cimetidine should be discontinued.
西咪替丁是一种组胺H2受体拮抗剂。它被广泛应用于临床，随之各种副作用也日益受到关注。急性间质性肾炎导致的急性肾衰竭是其最重要的不良反应之一。我们报告一例经活检证实的西咪替丁治疗后急性间质性肾炎病例。此外，我们回顾了其他报道的西咪替丁诱发急性间质性肾炎的病例，并讨论了这些西咪替丁诱发疾病的临床特征及免疫机制的作用。一名52岁女性因发热和蛋白尿入院。入院前一个月，她患上胃溃疡，附近的医生每天给她口服600毫克西咪替丁。入院时的实验室检查数据如下：白细胞计数14700/微升；嗜酸性粒细胞6%；血尿素氮50.7毫克/分升；肌酐7.6毫克/分升；C反应蛋白34.0毫克/分升。由于我们怀疑是药物性急性肾衰竭，尤其是西咪替丁所致，停用了所有药物。第3天进行的肾活检显示为间质性肾炎伴淋巴细胞浸润，主要由T细胞组成。T4/T8比值测定为1。T细胞亚群中辅助性细胞和细胞毒性细胞均无优势。我们回顾了报道的22例病例，并讨论了西咪替丁诱发间质性肾炎的特征。最重要的是，怀疑有这种疾病时要定期监测肾功能。一旦发现实验室数据异常，就应停用西咪替丁。
