摘要
目的分析急性间质性肾炎（AIN）的病因、临床特点、肾脏病理改变、治疗及转归。方法回顾性分析2007年1月至2010年10月郑州大学第一附属医院经肾活检确诊为AIN患者的病因、临床特点、肾脏病理结果、治疗措施及转归。结果①确诊为AIN患者共34例，其中药物相关性急性间质性肾炎（DAIN）27例，占79．4％，抗生素导致的AIN占DAIN的70．4％，最常见的抗生素依次为β-内酰胺类、氨基糖甙类、喹诺酮类、磺胺类。②临床表现有急性肾功能衰竭（ARF）（100％）、发热（64．7％）、蛋白尿（55．9％）、少尿或无尿（52．9％）、镜下血尿（41．2％）、白细胞尿（38．2％）、皮疹（32．4％）、尿糖（26．5％）及关节痛（14．7％）。⑧病理显示肾小管损伤轻重不等，肾小球及肾血管无明显病变。④18例（52．9％）口服强的松治疗，7例（20．6％）应用甲强龙冲击，7例（20．6％）行血液透析治疗，2例仅给予对症支持治疗；6周后，除2例患者未脱离透析，其他患者均明显好转.入院时患者平均血清尿素氮（BUN）为（19．9±7．3）mmol／L，肌酐（Ser）为（532±237）μmogL，尿酸（UA）为（415±141）μmol／L；治疗6周后，肾功能的各项指标均有明显降低，平均BUN为（7．4±2．7）mol/L，Scr为（133±85）μmol／L，UA为f309±94）μmol／L，与治疗前相比差异有统计学意义（P均〈0．01），疗效显著。结论AIN的常见致病因素为药物。临床表现呈多样性，无特异性，发热为其最常见的临床表现。临床及病理改变决定治疗措施，激素及血液透析是治疗AIN的有效方法，及时把握时机，并选取恰当的治疗方法是改善预后的关键。
Objective To analyze the cause, clinical features, renal pathology, treatment and prognosis of acute interstitial nephritis（ AIN）. Methods We pefforined a retrospective study of etiology,clinical features, pathology, treatment and prognosis for 34 renal biopsy specimen which were collected during the period of Jan. 2007 to Oct. 2010 in the First Affiliated Hospital of Zhengzhou University. Results ① Drug associated acute interstitial nephritis （DAIN） accounts for 79.4% of all AIN patients. AIN caused by antibiotics accounted for 70. 4% of DAIN, and the most com- mon antibiotics were β -lactams, aminoglycosides, quinolones, sulfonamides. ②The clinical features of AIN included acute renal failure （100%）, fever （64.7%）, proteinuria （55.9%）, oliguria or anuria （52. 9% ）, microscopic hematuria （41.2%）, leukourine （ 38.2% ）, rash （ 32.4% ）, glucosurine （26.5%） and arthralgia （ 14.7% ）. ③The pathology showed varying severity of renal tubular injury, but glomerular and renal vascular had no obvious lesions. ④Eighteen cases were treated by prednisone, 7 cases were given methylprednisolone, 7 cases required acute renal replacement therapy. Two patients were given only symptomatic and supportive treatment. After 6 weeks, most patients were significantly improved, but 2 cases still need dialysis. At frist, the patients＇ average BUN was （19.9 ± 7.3） retool/L, Scr was （532 ±237） μmol/L, UA was （415 ± 141 ） μmol/L, after the treatment about 6 weeks, patients＇ renal function indicators were significantly reduced, the average BUN was （7.4 ± 2.7） mmol/L, Scr was （133± 85） μmol/L, UA was （309 ± 94） μmol/L, compared with that before treatment, there were significant differences （ P 〈0. 01）. Conclusions The common causative factors of AIN are drugs. The clinical manifestations has diversity and no speficity. Fever is the most common clinical performance. Treatment relies on pathology. Hormones and blood dialysis is an effective method for
出处
《中国实用医刊》
2011年第16期28-30,共3页
Chinese Journal of Practical Medicine
关键词
急性间质性肾炎
药物相关急性间质性肾炎
肾活检
激素治疗
Acute interstitial nephritis
Drug associated acute interstitial nephritis
Renal biopsy
Hormone therapy
