Singh A K, Ucci A, Madias N E
Division of Nephrology, New England Medical Center, Boston, MA 02111, USA.
Am J Kidney Dis. 1996 Feb;27(2):273-8. doi: 10.1016/s0272-6386(96)90553-3.
Predominant tubulointerstitial lupus nephritis is rare. Only eight cases have been described in the literature. We report the case of a 59-year-old man with systemic lupus erythematosus who presented with acute renal failure. On renal biopsy, he was found to have chronic tubulointerstitial nephritis with a mononuclear infiltrate. The immunofluorescence showed immune deposits in the tubular basement membranes, interstitium, and glomerular capsule. The glomeruli were minimally involved. He was initially treated with high-dose corticosteroids and supported with hemodialysis. Renal function improved and dialysis was discontinued after three treatments. The corticosteroid dosage was gradually tapered. Renal function after 72 months of follow-up has remained stable (serum creatinine, approximately 1.9 mg/dL) and except for one relapse, there has been no clinical or serologic evidence of lupus activity. Furthermore, 24-hour urinary protein excretion has remained within the normal range.
以肾小管间质为主的狼疮性肾炎较为罕见。文献中仅描述过8例。我们报告一例59岁的系统性红斑狼疮男性患者，其表现为急性肾衰竭。肾活检发现他患有慢性肾小管间质性肾炎伴单核细胞浸润。免疫荧光显示在肾小管基底膜、间质和肾小球囊中有免疫沉积物。肾小球受累较轻。他最初接受大剂量皮质类固醇治疗，并辅以血液透析。肾功能改善，三次治疗后停止透析。皮质类固醇剂量逐渐减少。随访72个月后肾功能保持稳定（血清肌酐约1.9mg/dL），除一次复发外，无狼疮活动的临床或血清学证据。此外，24小时尿蛋白排泄一直保持在正常范围内。
