Nagai Kei, Tsukada Tsuyoshi, Sakata Akiko, Ueda Atsushi
Department of Nephrology, Hitachi General Hospital, 2-1-1 Jonan-Cho, Hitachi, Ibaraki 317-0077, Japan.
Department of Nephrology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan.
Case Rep Nephrol. 2022 Aug 5;2022:6203803. doi: 10.1155/2022/6203803. eCollection 2022.
Acute tubulointerstitial nephritis (ATIN) can be caused by any number of factors, and it accounts for several percent of renal biopsy cases. In Japan, case reports exist, but there are few single-center series of ATIN cases. . A teenage male patient developed fever and cough on day X-61 and was found to have normal renal function and positive C-reactive protein (CRP) by his primary care physician. On day X-20, he presented with cough and nasal discharge in addition to low-grade fever, and his doctor noted renal dysfunction with serum creatinine of 2.12 mg/dL, negative urine occult blood, and positive urine glucose. Renal biopsy results showed diffuse interstitial nephritis with scarce glomerular involvement. There was no concurrent uveitis. Renal function normalized after 4 months of treatment with moderate-dose prednisolone. . Of the 422 cases for which renal biopsies were performed at our institution from 2008 to 2021, acute tubulointerstitial nephritis was confirmed clinically and pathologically in 9 cases in addition to case 1, accounting for 2.4% of all biopsy cases. In the analysis of the 10 patients, the median age was 40 years old, eGFR at diagnosis was 19.4 (3.2-49.1) mL/min/1.73 m, and 2 of them underwent hemodialysis, but both were weaned from dialysis, and the eGFR after treatment was 53.6 (20.8-110.0) mL/min/1.73 m; all patients showed improvement ( < 0.001). Treatment consisted of steroids in 8 patients and no steroids in 2 patients, the latter being treated by discontinuation of the suspect drugs and treatment of infection; 7 of the 10 patients were examined for ocular uveitis, and uveitis was diagnosed in 5 patients. The causes and clinical course of ATIN are diverse, but it is treated according to individual judgment in addition to standard treatment, and it generally has a good renal prognosis.
急性肾小管间质性肾炎（ATIN）可由多种因素引起，在肾活检病例中占百分之几。在日本，有病例报告，但单中心的ATIN病例系列较少。一名青少年男性患者在第X - 61天出现发热和咳嗽，其初级保健医生发现他肾功能正常且C反应蛋白（CRP）呈阳性。在第X - 20天，他除了低热外还出现咳嗽和流涕，医生注意到他存在肾功能不全，血清肌酐为2.12mg/dL，尿潜血阴性，尿糖阳性。肾活检结果显示弥漫性间质性肾炎，肾小球受累较少。无并发葡萄膜炎。用中等剂量泼尼松龙治疗4个月后肾功能恢复正常。在我们机构2008年至2021年进行肾活检的422例病例中，除病例1外，另有9例经临床和病理确诊为急性肾小管间质性肾炎，占所有活检病例的2.4%。在对这10例患者的分析中，中位年龄为40岁，诊断时的估算肾小球滤过率（eGFR）为19.4（3.2 - 49.1）mL/min/1.73m²，其中2例接受了血液透析，但均已停止透析，治疗后的eGFR为53.6（20.8 - 110.0）mL/min/1.73m²；所有患者均有改善（P < 0.001）。8例患者接受了类固醇治疗，2例未接受类固醇治疗，后者通过停用可疑药物和治疗感染进行治疗；10例患者中有7例接受了眼部葡萄膜炎检查，5例被诊断为葡萄膜炎。ATIN的病因和临床过程多种多样，但除了标准治疗外，还需根据个体判断进行治疗，其肾脏预后一般良好。
