ter Borg E J, Tegzess A M, Kallenberg C G
Department of Internal Medicine, University Hospital Groningen, The Netherlands.
Clin Nephrol. 1988 Feb;29(2):93-5.
We describe a patient with systemic lupus erythematosus and impaired renal function probably mainly due to tubulointerstitial disease. After a six-week course of low-dose cyclosporine A, she developed a severe but reversible loss of glomerular filtration rate and effective renal plasma flow despite of low cyclosporine A plasma levels. Based upon the observed fall of the filtration fraction, the rise in the relative clearance of 99Tc-dimercaptosuccinic acid and the increase in proteinuria, we suggest that in this case the tubules and/or interstitium are the main targets for cyclosporine A nephrotoxicity. Neither our patient's clinical symptoms nor her serologic parameters improved possibly because of the low dosage and/or short duration of cyclosporine A treatment. We conclude that one should be cautious when treating patients with systemic lupus erythematosus and pre-existing renal disease with cyclosporine A especially when tubulointerstitial abnormalities are present and/or other nephrotoxic drugs are used.
我们描述了一名患有系统性红斑狼疮且肾功能受损的患者，其肾功能受损可能主要归因于肾小管间质性疾病。在接受为期六周的低剂量环孢素A治疗后，尽管其血浆中环孢素A水平较低，但她仍出现了严重但可逆的肾小球滤过率和有效肾血浆流量下降。基于观察到的滤过分数下降、99Tc - 二巯基丁二酸相对清除率升高以及蛋白尿增加，我们认为在该病例中，肾小管和/或间质是环孢素A肾毒性的主要靶点。我们的患者临床症状和血清学参数均未改善，可能是由于环孢素A治疗剂量低和/或疗程短。我们得出结论，在用环孢素A治疗患有系统性红斑狼疮和已有肾脏疾病的患者时应谨慎，尤其是当存在肾小管间质异常和/或使用其他肾毒性药物时。
