Bender W L, Whelton A, Beschorner W E, Darwish M O, Hall-Craggs M, Solez K
Am J Med. 1984 Jun;76(6):1006-12. doi: 10.1016/0002-9343(84)90849-0.
Nine patients with the unusual combination of renal failure, nephrotic-range proteinuria, and biopsy-proved interstitial nephritis are described. Six of these patients had received nonsteroidal anti-inflammatory agents (three fenoprofen, one ibuprofen, one zomepirac, and one tolmetin). The remaining three patients had no history of exposure to drugs known to cause interstitial nephritis. Immunologic characterization of the infiltrating cells with monoclonal antibodies showed that the majority of cells in most cases were cytotoxic T cells, although some B cells were present in all cases. Giant collecting duct cells were seen in half the patients with drug exposure but in none of the others. Otherwise, there were no conspicuous morphologic differences between patients with and without drug exposure. Many of the patients had associated glomerular abnormalities. Only the zomepirac and tolmetin recipients showed pure interstitial disease. The three fenoprofen recipients and the zomepirac and tolmetin recipients regained normal renal function after the drug was discontinued. The combination of renal failure, nephrotic range proteinuria, and interstitial nephritis is one form of nephrotoxicity observed in patients treated with nonsteroidal anti-inflammatory agents. However, this lesion, which may be mediated by cytotoxic T cells, may also be seen rarely in patients with no apparent drug exposure.
本文描述了9例患有肾衰竭、肾病范围蛋白尿且经活检证实为间质性肾炎的特殊病例组合。其中6例患者曾使用过非甾体抗炎药（3例使用苯氧洛芬、1例使用布洛芬、1例使用氯胺酮、1例使用托美丁）。其余3例患者无已知可导致间质性肾炎的药物接触史。用单克隆抗体对浸润细胞进行免疫特征分析显示，大多数病例中的大多数细胞为细胞毒性T细胞，不过所有病例中均存在一些B细胞。在有药物接触史的患者中有一半可见巨大集合管细胞，而在其他患者中均未见到。除此之外，有药物接触史和无药物接触史的患者之间在形态学上并无明显差异。许多患者伴有肾小球异常。只有使用氯胺酮和托美丁的患者表现为单纯间质性疾病。停用药物后，3例使用苯氧洛芬的患者以及使用氯胺酮和托美丁的患者肾功能恢复正常。肾衰竭、肾病范围蛋白尿和间质性肾炎的组合是使用非甾体抗炎药治疗的患者中观察到的一种肾毒性形式。然而，这种可能由细胞毒性T细胞介导的病变在无明显药物接触史的患者中也很少见。
