Handa S P
CMAJ. 1986 Dec 1;135(11):1278-81.
Between January 1979 and June 1985, 10 patients with acute allergic interstitial nephritis were seen in a clinical nephrology service at a large regional hospital. The onset of renal failure was temporally related to the use of a drug: a nonsteroidal anti-inflammatory agent (NSAID) (in four patients), cimetidine (in three), antibiotics (in two) or allopurinol (in one). The onset of renal failure was acute in three patients and insidious in seven. Two patients also exhibited marked proteinuria. Clinical features such as fever, rash, hematuria, pyuria with or without eosinophiluria, and mild to marked proteinuria had led to suspicion of the disease. The diagnosis was confirmed by renal biopsy findings of inflammatory cells, predominantly lymphocytes, plasma cells and eosinophils. Three patients required hemodialysis; two of them received steroids as well. Steroid therapy was also used in two patients with NSAID-induced proteinuria. Renal function improved in nine patients by 35 days, but one patient continued to have slow but progressive deterioration of renal function. Acute interstitial nephritis can be distinguished from other forms of acute renal failure by heavy renal uptake of gallium 67, maximal 48 hours or more after injection. The improvement in renal function after discontinuation of the implicated drug, the characteristic histopathological findings of allergic interstitial nephritis, and the presence of eosinophils and sometimes IgE in the blood suggest a hypersensitivity reaction.
1979年1月至1985年6月期间，一家大型地区医院的临床肾脏病科诊治了10例急性过敏性间质性肾炎患者。肾衰竭的发生在时间上与药物使用有关：非甾体抗炎药（4例）、西咪替丁（3例）、抗生素（2例）或别嘌醇（1例）。3例患者肾衰竭起病急，7例起病隐匿。2例患者还表现出明显蛋白尿。发热、皮疹、血尿、脓尿伴或不伴嗜酸性粒细胞尿以及轻度至重度蛋白尿等临床特征引发了对该病的怀疑。通过肾活检发现炎症细胞，主要是淋巴细胞、浆细胞和嗜酸性粒细胞，确诊了该病。3例患者需要血液透析；其中2例还接受了类固醇治疗。2例非甾体抗炎药引起蛋白尿的患者也使用了类固醇治疗。9例患者肾功能在35天内有所改善，但1例患者肾功能持续缓慢但进行性恶化。急性间质性肾炎可通过注射后48小时或更长时间镓67在肾脏的大量摄取与其他形式的急性肾衰竭相鉴别。停用相关药物后肾功能的改善、过敏性间质性肾炎的特征性组织病理学表现以及血液中嗜酸性粒细胞和有时IgE的存在提示过敏反应。
