Roberts J A, Kaack M B, Baskin G
Department of Urology, Tulane University, New Orleans, Louisiana.
J Urol. 1990 Jan;143(1):150-4. doi: 10.1016/s0022-5347(17)39900-7.
Previous studies show that chronic pyelonephritis and end stage renal disease may follow acute pyelonephritis in children and adolescents when improperly or inadequately treated. Our study shows that there is a significant decrease in renal function following untreated acute bacterial pyelonephritis due to nephron loss. The acute inflammatory response is responsible for much of the renal damage, although damage from renal ischemia is an additional significant factor. The present study used a combination of an antibiotic and a xanthine oxidase inhibitor (allopurinol) as compared to antibiotic therapy alone begun 72 hours after infection. Both were successful in eradicating the infection rapidly, but did not entirely prevent renal damage. Treatment prior to 72 hours thus is important. It appears that the combined treatment, designed to eradicate the bacteria as well as reduce the post-ischemic reperfusion damage and the phagocytic burst of phagocytosis is ideal, as this combined treatment was effective in preventing almost all renal damage and loss of renal function.
既往研究表明，儿童和青少年急性肾盂肾炎若治疗不当或不充分，可能会发展为慢性肾盂肾炎和终末期肾病。我们的研究表明，未经治疗的急性细菌性肾盂肾炎会因肾单位丧失而导致肾功能显著下降。急性炎症反应是造成大部分肾损伤的原因，尽管肾缺血造成的损伤也是一个重要因素。本研究采用抗生素与黄嘌呤氧化酶抑制剂（别嘌醇）联合治疗，并与感染72小时后单独使用抗生素治疗进行比较。两者均能迅速成功根除感染，但不能完全预防肾损伤。因此，在72小时之前进行治疗很重要。旨在根除细菌以及减少缺血后再灌注损伤和吞噬细胞吞噬爆发的联合治疗似乎是理想的，因为这种联合治疗有效地预防了几乎所有的肾损伤和肾功能丧失。
