Schubert C, Bates W D, Moosa M R
Division of Anatomical Pathology, Department of Pathology, NHLS (National health laboratory service), Cape Town, South Africa.
Clin Nephrol. 2010 Jun;73(6):413-9. doi: 10.5414/cnp73413.
Acute tubulointerstitial nephritis (ATIN) as a complication of antituberculous therapy has been most commonly reported due to rifampicin therapy. This reaction typically occurs following re-exposure to the drug. This study undertook to investigate the clinicopathological features of ATIN related to antituberculous therapy.
We performed a retrospective study of all adult patients with a biopsy-proven diagnosis of ATIN on chemotherapy for tuberculosis. The patients presented with acute renal failure at our institution during 1995 - 2007. The demographic, clinical, biochemical and histopathological features were studied. The patient outcome and management were analyzed.
41 patients had histologically proven ATIN. 23 (56%) were female. The mean age at presentation was 42 years. The most common regimen included rifampicin used intermittently to treat pulmonary tuberculosis. The average duration of antituberculosis therapy was 19 days before presentation and the duration of the acute illness averaged 5 days. The most common clinical manifestation included gastro-intestinal symptoms occurring in 35 (85%) patients with associated hepatitis biochemically in 20 (53%) patients. No skin rashes were observed and eosinophilia was only present in two patients. Hematuria was observed universally without any significant proteinuria. Anemia was present in 37 (90%) patients, with associated thrombocytopenia in 15 (37%). Rifampicin was discontinued in 37 (90%) cases. Nine (22%) patients required dialysis. One patient failed to recover renal function and 4 (10%) patients died. Mortality was related to overwhelming tuberculosis infection. The main factor predicting the need for dialysis was duration of oliguria.
ATIN is a rare, but serious complication of repeat antituberculous therapy mainly due to re-exposure to rifampicin. Although the renal prognosis is generally good the disease does carry significant morbidity and mortality risks. A high index of suspicion is needed in re-treatment patients. A suggested screening test is for microhematuria with urine dipstix.
急性肾小管间质性肾炎（ATIN）作为抗结核治疗的一种并发症，最常见于利福平治疗后。这种反应通常在再次接触该药物后发生。本研究旨在调查与抗结核治疗相关的ATIN的临床病理特征。
我们对所有经活检证实诊断为ATIN且正在接受结核病化疗的成年患者进行了一项回顾性研究。这些患者于1995年至2007年期间在我院出现急性肾衰竭。研究了患者的人口统计学、临床、生化和组织病理学特征。分析了患者的预后和治疗情况。
41例患者经组织学证实为ATIN。23例（56%）为女性。就诊时的平均年龄为42岁。最常见的治疗方案包括间歇性使用利福平治疗肺结核。抗结核治疗的平均疗程为就诊前19天，急性疾病的平均病程为5天。最常见的临床表现包括35例（85%）患者出现胃肠道症状，20例（53%）患者伴有生化指标异常的肝炎。未观察到皮疹，仅2例患者出现嗜酸性粒细胞增多。普遍观察到血尿，无明显蛋白尿。37例（90%）患者出现贫血，15例（37%）患者伴有血小板减少。37例（90%）患者停用了利福平。9例（22%）患者需要透析。1例患者肾功能未能恢复，4例（10%）患者死亡。死亡率与严重的结核感染有关。预测需要透析的主要因素是少尿持续时间。
ATIN是重复抗结核治疗的一种罕见但严重的并发症，主要由于再次接触利福平。尽管肾脏预后通常良好，但该疾病确实存在显著的发病率和死亡率风险。再次治疗的患者需要高度怀疑。建议的筛查试验是用尿试纸检测微量血尿。
