Hirano K, Tomino Y, Mikami H, Ota K, Aikawa Y, Shirato I, Koide H
Department of Medicine, Juntendo University School of Medicine, Tokyo, Japan.
Am J Nephrol. 1989;9(6):499-503. doi: 10.1159/000168020.
A 23-year-old female with acute renal failure associated with acute tubulointerstitial nephritis and uveitis is reported. Renal tubular acidosis and inflammatory reactions consisting of markedly increased erythrocyte sedimentation rate and high serum immunoglobulin levels were seen on admission. Light microscopy revealed infiltration of mononuclear cells in the interstitium. Immunofluorescence of renal tissues was negative in staining for immunoglobulins, fibrinogen, and complement components. Bone marrow specimens did not show any granulomatous lesions. The etiology of this tubulointerstitial nephritis and uveitis syndrome was not clear. Immunological evaluation showed a slight decrease of the OKT4/OKT8 ratio in the peripheral blood. OKT8- and OKM1-positive cells had infiltrated diffusely into the renal interstitium. Acute tubulointerstitial nephritis and uveitis responded dramatically to steroid therapy. It was suggested that immunological factors might correlate with the onset and/or development of this syndrome. It is indicated that high-dose steroid therapy might be useful for patients with acute interstitial nephritis and uveitis.
报告了一名23岁患有急性肾衰竭并伴有急性肾小管间质性肾炎和葡萄膜炎的女性患者。入院时可见肾小管酸中毒以及炎症反应，表现为红细胞沉降率显著升高和血清免疫球蛋白水平升高。光镜检查显示间质中有单核细胞浸润。肾组织免疫荧光检查在免疫球蛋白、纤维蛋白原和补体成分染色方面呈阴性。骨髓标本未显示任何肉芽肿性病变。这种肾小管间质性肾炎和葡萄膜炎综合征的病因尚不清楚。免疫学评估显示外周血中OKT4/OKT8比值略有下降。OKT8和OKM1阳性细胞已弥漫性浸润到肾间质。急性肾小管间质性肾炎和葡萄膜炎对类固醇治疗反应显著。提示免疫因素可能与该综合征的发生和/或发展相关。表明大剂量类固醇治疗可能对急性间质性肾炎和葡萄膜炎患者有用。
