Ueda Hideki, Ishimura Eiji, Yunoki Takayuki, Tsuchida Takao, Matsumoto Naoki, Jono Syuichi, Imanishi Yasuo, Inaba Masaaki, Nishizawa Yoshiki
Department of Nephrology, Osaka City University Graduate School of Medicine, Osaka, Japan.
Department of Internal Medicine, Shimada Hospital, 100-1 Kashiyama, Habikino, Osaka, 583-0875, Japan.
Clin Exp Nephrol. 2005 Dec;9(4):332-334. doi: 10.1007/s10157-005-0382-7.
We describe a 75-year-old man with tubulointerstitial nephritis (TIN) with myeloperoxidase (MPO)-antineutrophil antibody (ANCA) and proteinase-3 (PR3)-ANCA. He had a slight fever and eruption with itching after taking cimetidine (prescribed after gastrectomy for gastric cancer) and he was admitted to a nearby hospital. There, he showed proteinuria, serum creatinine (sCr) of 2.9 mg/dl, and creatinine clearance (Ccr) of 44 ml/min per 1.73 m2. His MPO-ANCA titer was 267 EU, and PR3-ANCA titer was 112 EU. Abnormal concentrations in bilateral kidneys were found by gallium scintigraphy. For these reasons, he was transferred to our hospital. Percutaneous renal biopsy was performed after admission. Severe tubular atrophy, mild interstitial fibrosis, and severe mononuclear cell infiltration of the interstitium were noted. Drug-induced renal impairment was suspected, and cimetidine administration was withdrawn. Lymphocyte stimulation tests (DLSTs) were performed. The cimetidine titer was positive, at 2,537 cpm. After the withdrawal of cimetidine, the PR3-ANCA titer was reduced gradually, and, next, the MPO-ANCA titer was also reduced. The sCr level was reduced to 1.2 mg/dl. In summary, we report herein the first case of cimetidine-induced TIN associated with both MPO-ANCA and PR3-ANCA.
我们描述了一名75岁男性，患有伴有髓过氧化物酶（MPO）-抗中性粒细胞抗体（ANCA）和蛋白酶3（PR3）-ANCA的肾小管间质性肾炎（TIN）。他在服用西咪替丁（胃癌胃切除术后开具）后出现低热及伴有瘙痒的皮疹，并入住附近医院。在该院，他出现蛋白尿，血清肌酐（sCr）为2.9mg/dl，肌酐清除率（Ccr）为每1.73m² 44ml/min。他的MPO-ANCA滴度为267EU，PR3-ANCA滴度为112EU。镓闪烁扫描发现双侧肾脏浓度异常。基于这些原因，他被转至我院。入院后进行了经皮肾活检。结果显示严重的肾小管萎缩、轻度间质纤维化以及间质严重单核细胞浸润。怀疑为药物性肾损害，停用了西咪替丁。进行了淋巴细胞刺激试验（DLSTs）。西咪替丁滴度呈阳性，为2537cpm。停用西咪替丁后，PR3-ANCA滴度逐渐降低，随后MPO-ANCA滴度也降低。sCr水平降至1.2mg/dl。总之，我们在此报告首例西咪替丁诱导的同时伴有MPO-ANCA和PR3-ANCA的TIN病例。
