Chang Anthony, Peutz-Kootstra Carine J, Kowalewska Jolanta, Logar Christine M, Gitomer Jeremy J, Davis Connie L, Shankland Stuart J, Alpers Charles E, Smith Kelly D
Department of Pathology, University of Washington Medical Center, Seattle, Washington, USA.
Clin J Am Soc Nephrol. 2006 Sep;1(5):920-4. doi: 10.2215/CJN.02201205. Epub 2006 Jul 12.
This paper presents two elderly patients who had normal baseline renal function and had stenotic valvular lesions secondary to rheumatic fever and underwent aortic valve replacements with mechanical valves. Both patients developed acute renal failure after cardiac valve replacement procedures. The renal biopsies revealed acute granulomatous tubulointerstitial nephritis. The unique histologic features were tubular basement membrane (TBM) immune complex deposition detected by both immunofluorescence and electron microscopy and prominent multinucleated giant cells surrounding intact TBM. The temporal relationship to the surgical procedure and the subsequent recovery of the patients' renal functions upon therapy suggested that the renal failure may have been due to an allergic drug reaction from the perioperative exposure to unknown agents, such as prophylactic antibiotics and furosemide. The literature on TBM immune complex deposition was reviewed, and the pathophysiologic mechanisms that may account for the similarities between the clinicopathologic features of these two cases were examined. These two cases expand the histopathologic spectrum of previously described cases of putative drug-induced acute tubulointerstitial nephritis.
本文介绍了两名老年患者，他们基线肾功能正常，患有风湿热继发的狭窄瓣膜病变，并接受了机械瓣膜主动脉瓣置换术。两名患者在心脏瓣膜置换术后均发生急性肾衰竭。肾活检显示为急性肉芽肿性肾小管间质性肾炎。独特的组织学特征是通过免疫荧光和电子显微镜检测到的肾小管基底膜（TBM）免疫复合物沉积，以及围绕完整TBM的突出多核巨细胞。与手术过程的时间关系以及患者治疗后肾功能的随后恢复表明，肾衰竭可能是由于围手术期接触未知药物（如预防性抗生素和速尿）引起的过敏药物反应。回顾了关于TBM免疫复合物沉积的文献，并研究了可能解释这两个病例临床病理特征相似性的病理生理机制。这两个病例扩展了先前描述的疑似药物性急性肾小管间质性肾炎病例的组织病理学谱。
