Kleinknecht D
Service de Nephrologie et de Réanimation polyvalente, Centre Hospitalier, Montreuil.
Ann Med Interne (Paris). 1988;139(2):100-2.
Acute interstitial nephritis (AIN) due to drug hypersensitivity represents 0.8 to 8 p. 100 of all causes of acute renal failure. Two thirds of cases are due to antibiotics, mainly beta-lactamines, and to non-steroidal anti-inflammatory drugs. Blood hypereosinophilia, fever, arthralgias and/or hepatocellular damage are suggestive of an allergic drug reaction in patients with AIN, with a sensitivity of 0.75 and a specificity of 0.76. Examination of an early renal biopsy specimen is a clue to the diagnosis of AIN due to drug hypersensitivity if it discloses a diffuse or focal interstitial infiltration with lymphocytes, plasma cells, and mainly by eosinophils and/or epithelioid cell granulomas. These findings suggest a delayed hypersensitivity reaction, although many cases seem to be also mediated by humoral immune factors. Renal recovery is frequent when the responsible drug is promptly withdrawn. The value of steroid therapy in preventing residual renal damage has to be assessed by controlled studies.
药物超敏反应所致的急性间质性肾炎（AIN）占急性肾衰竭所有病因的0.8%至8%。三分之二的病例由抗生素引起，主要是β-内酰胺类抗生素，以及非甾体类抗炎药。血液嗜酸性粒细胞增多、发热、关节痛和/或肝细胞损伤提示AIN患者发生了药物过敏反应，其敏感性为0.75，特异性为0.76。如果早期肾活检标本显示淋巴细胞、浆细胞弥漫性或局灶性间质浸润，主要为嗜酸性粒细胞和/或上皮样细胞肉芽肿，则是药物超敏反应所致AIN诊断的线索。这些发现提示为迟发型超敏反应，尽管许多病例似乎也由体液免疫因素介导。及时停用相关药物后，肾脏常可恢复。类固醇疗法在预防残留肾损害方面的价值必须通过对照研究来评估。
