Cogan M C, Arieff A I
Am J Med. 1978 Mar;64(3):500-7. doi: 10.1016/0002-9343(78)90237-1.
A 61 year old male patient was studied who manifested dehydration, azotemia, acidosis and hyperkalemia six weeks after exposure to methicillin. Thyroid and adrenal glucocorticoid and mineralocorticoid function were normal. The dehydration was found to be caused by a profound sodium-losing nephropathy; urinary sodium ranged from 78 to 101 meq/day during a salt restricted diet. A distal renal tubular acidosis and a quantitively impaired ability to excrete potassium were also found. These defects were relatively unresponsive to mineralocorticoid or prednisone therapy. A renal biopsy specimen showed an interstitial nephritis which selectively affected distal tubules and was thought to be secondary to methicillin. The data suggest functional impairment specific for the distal tubule, but with only a modest decrease in the glomerular filtration rate.
对一名61岁男性患者进行了研究，该患者在接触甲氧西林六周后出现脱水、氮质血症、酸中毒和高钾血症。甲状腺、肾上腺糖皮质激素和盐皮质激素功能正常。发现脱水是由严重的失钠性肾病引起的；在限盐饮食期间，尿钠范围为每天78至101毫当量。还发现了远端肾小管酸中毒和排泄钾的能力定量受损。这些缺陷对盐皮质激素或泼尼松治疗反应相对不敏感。肾活检标本显示间质性肾炎，选择性地影响远端肾小管，被认为是甲氧西林继发的。数据表明远端肾小管存在特异性功能损害，但肾小球滤过率仅略有下降。
