Guenel J, Chevet D
Services de Néphrologie, C.H.R.U., Nantes.
Nephrologie. 1988;9(6):253-7.
Interstitial Nephritis (IN) with or without epithelioid granulomas is the most frequent form of renal impairment in sarcoidosis. Nevertheless, few studies have provided conclusions about its treatment and long-term outcome. We report 22 cases collected over a 20-year period in 9 nephrologic departments of the west of France. We discuss the criteria which permit sarcoidosis to be distinguished from other causes, particularly of IN drugs. Twenty patients were treated with corticoids. In 18 the result could be evaluated on at least 12 months. In 11 there was a decrease of plasma creatinine (Pc) and in 8 of these cases this decrease reached 50%. Of the 12 who were followed from 1 to 17 years, 4 obtained a reduction of Pc of at least 50%. These improvements occurred even in patients whose Pc was initially higher than 300 mumol/l. Only 2 patients reached end-stage renal failure and hemodialysis within the observation period, one as early as the first month, the other after 6 years. Five relapses were observed after stopping treatment but 4 responded again favorably upon resumption. Two patients who received no treatment at all nevertheless had stabilization or improvement of their renal function with a follow-up of 5 years for one case. It may be concluded that the long-term prognosis of sarcoidosis IN can be fairly good but there is no proof that it depends mainly on corticosteroid therapy.
伴有或不伴有上皮样肉芽肿的间质性肾炎（IN）是结节病中最常见的肾功能损害形式。然而，关于其治疗和长期预后的研究结论较少。我们报告了在法国西部9个肾脏病科20年期间收集的22例病例。我们讨论了可将结节病与其他病因，特别是药物性间质性肾炎相鉴别的标准。20例患者接受了皮质类固醇治疗。其中18例的结果可在至少12个月时进行评估。11例患者血浆肌酐（Pc）下降，其中8例下降幅度达到50%。在随访1至17年的12例患者中，4例患者的Pc至少降低了50%。即使是Pc最初高于300μmol/l的患者也出现了这些改善。在观察期内，只有2例患者发展至终末期肾衰竭并接受血液透析，1例在第一个月就出现，另1例在6年后出现。停药后观察到5例复发，但4例在重新治疗后再次出现良好反应。2例未接受任何治疗的患者，其中1例随访5年，其肾功能仍保持稳定或有所改善。可以得出结论，结节病性间质性肾炎的长期预后可能相当良好，但尚无证据表明其主要取决于皮质类固醇治疗。
