Figueiredo Ana Carolina, Rodrigues Luís, Sousa Vítor, Alves Rui
Nephrology Department, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal.
Universidade de Coimbra Faculdade de Medicina, Coimbra, Portugal.
BMJ Case Rep. 2019 Aug 10;12(8):e229159. doi: 10.1136/bcr-2018-229159.
Granulomatous interstitial nephritis (GIN) is a rare entity identified in <1% of native kidney biopsies. The most frequent aetiology is drug-related, followed by systemic granulomatous conditions. Among drugs implicated in GIN, antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs) are the most frequent. We report the case of a 45-year-old white man referred to a nephrology consult due to chronic kidney disease. He had a history of arterial hypertension with 10 years of evolution, hyperuricaemia, medicated with allopurinol and NSAID abuse for at least 20 years. Urine sediment was blunt, without proteinuria. Renal ultrasound was normal. A kidney biopsy revealed well-defined epithelioid granulomas with glomerular wrinkling and collapse. Infectious and systemic conditions were excluded, favouring the hypothesis of drug-induced GIN, probably related to NSAIDs. Kidney biopsy remains the gold standard for the diagnosis of GIN. Facing a patient with renal failure without significant proteinuria or active sediment, one should look for causes of tubulointerstitial injury.
肉芽肿性间质性肾炎（GIN）是一种罕见疾病，在<1%的自体肾活检中被发现。最常见的病因与药物相关，其次是系统性肉芽肿性疾病。在与GIN相关的药物中，抗生素和非甾体抗炎药（NSAIDs）最为常见。我们报告了一例45岁白人男性因慢性肾病转诊至肾脏科会诊的病例。他有10年动脉高血压病史、高尿酸血症，服用别嘌醇，且滥用NSAIDs至少20年。尿沉渣检查未见异常，无蛋白尿。肾脏超声检查正常。肾活检显示明确的上皮样肉芽肿，伴有肾小球皱缩和塌陷。排除了感染性和系统性疾病，支持药物性GIN的假设，可能与NSAIDs有关。肾活检仍是诊断GIN的金标准。面对无明显蛋白尿或活动性尿沉渣的肾衰竭患者，应寻找肾小管间质损伤的原因。
