Pusey C D, Saltissi D, Bloodworth L, Rainford D J, Christie J L
Q J Med. 1983 Spring;52(206):194-211.
Nine episodes of drug associated acute interstitial nephritis, in seven patients, were treated between 1972 and 1980. The drugs implicated were cotrimoxazole (three times), ampicillin, Magnapen (ampicillin and flucloxacillin), penicillin, gentamicin, paracetamol and bendrofluazide. The time from exposure to the onset of symptoms ranged from one to 30 days. Presentation was with acute renal failure, which was non-oliguric in five cases, accompanied by rash (four), fever (four), and loin pain (two). Renal biopsy was carried out in all cases, and showed a characteristic interstitial infiltrate comprising substantial numbers of lymphocytes and plasma cells, with a variable number of neutrophils, eosinophils and histiocytes. Immunofluorescence was negative in all four cases studied in the acute phase, and showed scattered deposits of IgG, IgM, IgA and C3 on the tubular basement membrane in one patient during recovery. Significant proteinuria and an abnormal urine deposit were present in all cases, and seven of nine had radiological evidence of enlarged kidneys. Seven episodes were treated with high doses of methyl prednisolone and in all there was a response with a diuresis or spontaneous fall in serum creatinine within 72 hrs, and recovery of virtually normal renal function. Of two cases who did not initially receive steroids, one improved more slowly and one developed chronic renal impairment.
1972年至1980年间，对7例患者的9次药物相关性急性间质性肾炎发作进行了治疗。涉及的药物有复方新诺明（3次）、氨苄西林、美格西（氨苄西林和氟氯西林）、青霉素、庆大霉素、对乙酰氨基酚和苄氟噻嗪。从接触药物到出现症状的时间为1至30天。表现为急性肾衰竭，5例为非少尿型，伴有皮疹（4例）、发热（4例）和腰痛（2例）。所有病例均进行了肾活检，显示特征性的间质浸润，包括大量淋巴细胞和浆细胞，伴有数量不等的中性粒细胞、嗜酸性粒细胞和组织细胞。急性期研究的4例中免疫荧光均为阴性，1例恢复过程中在肾小管基底膜上可见IgG、IgM、IgA和C3的散在沉积。所有病例均有明显蛋白尿和异常尿沉渣，9例中有7例肾脏有影像学证据显示增大。7次发作采用大剂量甲基泼尼松龙治疗，所有病例均有反应，72小时内出现利尿或血清肌酐自发下降，肾功能几乎恢复正常。2例最初未接受类固醇治疗的患者，1例改善较慢，1例发展为慢性肾功能损害。
