Makino H, Haramoto T, Sasaki T, Hironaka K, Shikata K, Takahashi K, Ota Z
Third Department of Internal Medicine, Okayama University Medical School, Japan.
Am J Kidney Dis. 1995 Jul;26(1):62-7. doi: 10.1016/0272-6386(95)90155-8.
The pathologic feature of acute interstitial nephritis is the infiltration of mononuclear cells, predominantly lymphocytes and monocytes, into the interstitium. We present an unusual case of a 49-year-old man with drug-induced acute interstitial nephritis whose renal biopsy specimen showed a massive infiltration of eosinophils into the interstitium and eosinophils infiltrating into the glomerulus through a gap in Bowman's capsule and the juxtaglomerular zone. The patient initially was referred to us with a recurrence of the nephrotic syndrome. Deterioration of renal function and an increase in proteinuria was noted at that time. Triazolam, a sleep inducer, was the suspected cause of the acute interstitial nephritis. Renal biopsy revealed sclerotic glomeruli containing eosinophils among massive infiltrated eosinophils and a loss of endothelial cells and mesangial cells in contrast to a preservation of epithelial cells. Infiltrating eosinophils were directly attached to the glomerular basement membrane, and free granules from the eosinophils were observed in the capillary lumen. In addition to chronic sclerotic change, eosinophils may have further damaged the glomerular capillary wall, leading to an increased severity of proteinuria in this case.
急性间质性肾炎的病理特征是单核细胞（主要是淋巴细胞和单核细胞）浸润至间质。我们报告一例不同寻常的病例，一名49岁男性患有药物性急性间质性肾炎，其肾活检标本显示间质有大量嗜酸性粒细胞浸润，且嗜酸性粒细胞通过鲍曼囊和肾小球旁区的间隙浸润至肾小球。该患者最初因肾病综合征复发被转诊至我们科室。当时发现肾功能恶化且蛋白尿增加。怀疑三唑仑（一种助眠药物）是急性间质性肾炎的病因。肾活检显示，在大量浸润的嗜酸性粒细胞中有含嗜酸性粒细胞的硬化肾小球，与上皮细胞保存完好形成对比的是，内皮细胞和系膜细胞缺失。浸润的嗜酸性粒细胞直接附着于肾小球基底膜，且在毛细血管腔内观察到来自嗜酸性粒细胞的游离颗粒。除了慢性硬化改变外，嗜酸性粒细胞可能进一步损害了肾小球毛细血管壁，导致该病例中蛋白尿严重程度增加。
