Alvarez Navascués R, Bastardo Z, Fernández Díaz M, Guerediaga J, Quiñones L, Pinto J
Servicio de Nefrología Hospital San Augustín Camino de Heros, 4 33400 Avilés.
Nefrologia. 2003 Jul-Aug;23(4):355-8.
Loratadine is a second generation histamine H1 receptor antagonist, that has high potency antiallergic properties and is associated with low adverse effects compared with other antihistamines. Acute interstitial nephritis is a cause of acute renal failure that is most often induced by drugs or, less frequently, infection or sarcoidosis. Although the number of drugs associated with acute intersticial nephritis is too large, the antihistaminic loratadine have never been reported before. We report a case of an interstitial nephritis with acute renal failure that suggesting hypersensitivity reaction in a 77 old man who had received loratadine (10 mg/day) during ten days before his assessment to our hospital by disseminated pruritic syndrome. The initial suspect was rapidly progressive glomerulonephitis and renal biopsy was practice and treatment with corticosteroids were initiated (prednisone bolus of 500 mg three days and 1 mg/kg/day/later). The loratadine therapy was cessation. He exhibiting a slow and progressive improvement on renal function and one month later, urea and creatinine levels was normal and hematuria and proteinuria had disappeared. The corticosteroids therapy were progressive decreased until withdrawal. We think that this is an interesting case, basing in its clinical presentation and that it had never been reported before.
氯雷他定是第二代组胺H1受体拮抗剂，具有高效的抗过敏特性，与其他抗组胺药相比不良反应较少。急性间质性肾炎是急性肾衰竭的一个病因，最常见由药物引起，较少由感染或结节病引起。虽然与急性间质性肾炎相关的药物数量众多，但抗组胺药氯雷他定此前从未有过相关报道。我们报告一例急性肾衰竭伴间质性肾炎病例，该病例提示过敏反应，患者为一名77岁男性，在因全身性瘙痒综合征到我院就诊前10天服用氯雷他定（10毫克/天）。最初怀疑为快速进展性肾小球肾炎，并进行了肾活检，开始使用皮质类固醇治疗（三天内给予500毫克泼尼松龙冲击治疗，之后为1毫克/千克/天）。停用氯雷他定治疗。他的肾功能呈缓慢渐进性改善，一个月后，尿素和肌酐水平恢复正常，血尿和蛋白尿消失。逐渐减少皮质类固醇治疗直至停药。基于其临床表现且此前从未有过报道，我们认为这是一个有趣的病例。
