Kumagai H, Hatama S, Yoshimitsu T
Third Department of Internal Medicine, Hiroshima Red Cross and Atomic Bomb Surviver Hospital.
Nihon Rinsho. 1995 Aug;53(8):2057-63.
Chronic tubulointerstitial nephritis is a chronic disorder that primarily affects the renal tubules and interstitium while sparing the glomeruli and vasculature. Although there are variable underlying causes, 10% to 25% of the cases of chronic tubulointerstitial nephritis are entirely idiopathic. A thorough search for the underlying causes of chronic tubulointerstitial nephritis is especially important because to avoid or to correct such underlying causes may prevent progression or even allow for some reversal of renal failure. Thus, diagnosis of idiopathic form of chronic tubulointerstitial nephritis is carefully made after the exclusion of potential underlying causes. The major pathologic features of idiopathic chronic tubulointerstitial nephritis are 1) interstitial fibrosis, 2) tubular atrophy and 3) infiltration of the parenchyma with mononuclear inflammatory cells. Of these three features, the extent of interstitial fibrosis is significantly correlated with decreased glomerular filtration rate and progression rate of renal failure. Idiopathic chronic tubulointerstitial nephritis seems to be slowly progressive and develop to end stage renal failure. Since there is no specific treatment for idiopathic chronic tubulointerstitial nephritis, avoidance and correction of exacerbation factors are essential for progression to renal failure. It is acceptable that protein-restricted diet be applied to idiopathic chronic tubulointerstitial nephritis although its effects on the disease still remain equivocal.
慢性肾小管间质性肾炎是一种慢性疾病，主要影响肾小管和肾间质，而肾小球和血管则不受影响。尽管潜在病因各不相同，但10%至25%的慢性肾小管间质性肾炎病例完全是特发性的。彻底寻找慢性肾小管间质性肾炎的潜在病因尤为重要，因为避免或纠正这些潜在病因可能会阻止肾衰竭的进展，甚至使其有所逆转。因此，在排除潜在病因后，需谨慎诊断特发性慢性肾小管间质性肾炎。特发性慢性肾小管间质性肾炎的主要病理特征为：1）间质纤维化；2）肾小管萎缩；3）实质内单核炎性细胞浸润。在这三个特征中，间质纤维化的程度与肾小球滤过率降低及肾衰竭进展速度显著相关。特发性慢性肾小管间质性肾炎似乎呈缓慢进展，最终发展为终末期肾衰竭。由于特发性慢性肾小管间质性肾炎尚无特效治疗方法，避免和纠正加重因素对于预防肾衰竭进展至关重要。对于特发性慢性肾小管间质性肾炎患者，采用蛋白质限制饮食是可行的，尽管其对该疾病的影响仍不明确。
