Monnin E, Bories P, Canaud B, Béraud J J, Baldet P, Mirouze J, Michel H
Gastroenterol Clin Biol. 1984 Mar;8(3):264-8.
Various types of allergic accidents have been reported with clometacin (Duperan), a synthetic analgesic introduced in France in 1971. The most prominent is hepatitis in elderly women, with hyperglobulinemia, eosinophilia, autoantibodies and giant multinucleated hepatocytes. The case presented herein concerns a 73-year-old woman who, on two separate occasions after the ingestion of clometacin at recommended dosages, developed at the same time typical acute hepatitis and non-oliguric acute renal failure. The second episode came soon after the medication was inadvertently reintroduced. Both hepatic and renal involvements were fully reversible. A renal biopsy showed predominant lesions of acute interstitial nephritis and tubulonecrosis. Three possible mechanisms are discussed: 1) sensitivity of the kidney to drugs because of preceding angiosclerosis, 2) impaired regulation of renal blood flow because of clometacin provoked decrease of prostaglandin synthesis, and 3) as in the case of nephrotoxicity due to other medications, allergic mechanisms.
1971年在法国上市的合成镇痛药氯灭酸（Duperan）已报告了各种类型的过敏事故。最突出的是老年女性的肝炎，伴有高球蛋白血症、嗜酸性粒细胞增多、自身抗体和巨大多核肝细胞。本文介绍的病例是一名73岁女性，在两次按推荐剂量服用氯灭酸后，同时出现了典型的急性肝炎和非少尿型急性肾衰竭。第二次发作是在无意中重新用药后不久出现的。肝脏和肾脏的病变均完全可逆。肾活检显示主要病变为急性间质性肾炎和肾小管坏死。讨论了三种可能的机制：1）由于先前的血管硬化，肾脏对药物敏感；2）氯灭酸引起的前列腺素合成减少导致肾血流调节受损；3）与其他药物引起的肾毒性情况一样，存在过敏机制。
