Ceylan Kadir, Karahocagil Mustafa Kasim, Soyoral Yasemin, Sayarlioğlu Hayriye, Karsen Hasan, Dogan Ekrem, Akdeniz Hayrettin, Bayram Irfan, Kösem Mustafa, Erkoc Reha
Department of Urology, Yüzüncü Yil University Medical Faculty, Van, Turkey.
Urology. 2009 Jun;73(6):1179-83. doi: 10.1016/j.urology.2008.01.063. Epub 2009 Apr 18.
To examine our patients with brucellosis and renal involvement. Although brucellae have been recovered from the urine of patients with brucellosis, renal involvement is uncommon.
The data from 15 patients (8 males and 7 females, mean age 43 +/- 18.9 years, range 16 to 80), who had been admitted to our hospital with the diagnosis of brucellosis with renal involvement from 1998 to 2006, were retrospectively evaluated.
In almost all cases, urinalysis revealed hematuria and variable amounts of proteinuria; some of the patients had pyuria. Of the 15 patients, 14 had renal failure. The etiology of renal failure was prerenal azotemia in 1, acute tubular necrosis because of nonsteroidal anti-inflammatory drug use in 1, anuric tubulointerstitial nephritis due to rifampin use in 1, nephritis accompanied by brucellar endocarditis in 3, brucellar endocarditis and tubulointerstitial nephritis-associated vasculitis in 1, brucellar membranoproliferative glomerulonephritis in 1, and brucellar tubulointerstitial nephritis clinically in 6 patients. Hemodialysis was required in 5 patients. Chronic renal failure developed in 1 patient, 2 patients were lost to follow-up, and renal function completely recovered in 11 patients. Two patients underwent renal biopsy and membranoproliferative glomerulonephritis with intraglomerular infiltration of histiocytes was identified in 1 patient and chronic tubulointerstitial nephritis associated with vasculitis and immune complex nephritis features was identified in the other.
In areas endemic for brucellosis, this infection can be associated with hematuria, proteinuria, and renal failure. In addition, many diverse etiologies can play a role in the renal involvement associated with Brucella infection.
对我院患有布鲁氏菌病且累及肾脏的患者进行检查。尽管已从布鲁氏菌病患者的尿液中分离出布鲁氏菌，但肾脏受累情况并不常见。
回顾性评估了1998年至2006年间我院收治的15例诊断为布鲁氏菌病累及肾脏的患者（8例男性，7例女性，平均年龄43±18.9岁，年龄范围16至80岁）的数据。
几乎所有病例的尿液分析均显示血尿和不同程度的蛋白尿；部分患者有脓尿。15例患者中，14例出现肾衰竭。肾衰竭的病因包括：1例为肾前性氮质血症，1例因使用非甾体类抗炎药导致急性肾小管坏死，1例因使用利福平导致无尿性肾小管间质性肾炎，3例为伴有布鲁氏菌性心内膜炎的肾炎，1例为布鲁氏菌性心内膜炎及肾小管间质性肾炎相关血管炎，1例为布鲁氏菌性膜增生性肾小球肾炎，6例临床上为布鲁氏菌性肾小管间质性肾炎。5例患者需要进行血液透析。1例患者发展为慢性肾衰竭，2例患者失访，11例患者肾功能完全恢复。2例患者接受了肾活检，1例患者被诊断为伴有组织细胞肾小球内浸润的膜增生性肾小球肾炎，另1例患者被诊断为与血管炎及免疫复合物肾炎特征相关的慢性肾小管间质性肾炎。
在布鲁氏菌病流行地区，这种感染可伴有血尿、蛋白尿和肾衰竭。此外，多种不同病因可在与布鲁氏菌感染相关的肾脏受累中起作用。
