摘要
目的了解急性间质性肾炎(AIN)的病因、临床表现、肾病理改变。方法回顾性分析我院自1996年4月至2005年4月肾活检确诊为AIN的患者的临床表现、病理改变、糖皮质激素治疗疗效等。结果①肾活检病例为1352例,确诊为AIN 41例(3.03%)。②药物相关性AIN87.8%,抗生素所致的AIN77.78%。③临床表现包括发热(61.98%),无尿或少尿(61.98%),白细胞尿(48.78%),糖尿(26.83%),皮疹(17.07%),关节痛(12.20%)。26.83%患者需透析替代治疗。④32例(78.04%)患者经甲基泼尼松龙冲击治疗或予口服泼尼松治疗1月后,43.9%的患者肾功能恢复正常,除1例死亡外,其余患者均摆脱透析治疗。⑤治疗1月后肾功能未恢复正常者与肾功能恢复正常者相比,前者原有肾脏病的比例高(43.48%vs11.11%,P=0.026),发病时出现尿糖阳性的比率高(47.82%vs11.11%P=0.0133),但肾组织学上无明显差异。结论AIN临床表现多样,药物是AIN最常见的致病因素。原有肾脏疾病,病程中出现糖尿是预后不良的重要指标。
Purpose To investigate the cause, clinical characteristics, renal pathology of acute interstitial nephritis（AIN） and to evaluate the treatment of this disorder. Methods We performed a retrospective study of 1352 renal biopsy specimen which were collected during the period of Apt, 1996- Apt, 2005, from our hospital. Clinical, laboratory and histological features were identified and all patients were followed up for at least 1 month after treatment. Results ①AIN was found in 3.03 % （n = 41） of all 1352 native biopsies. ② Drug related AIN accounts for 87.8% （n = 36） of all AIN patients, including antibiotics-related AIN 77. 78% （n = 28）. The clinical features included fever （61.98%） ,oliguria （61.98%） ,leukourine （48. 78%）, glucosurine（26. 83%）, arthralgia（12.2%） and rash （17. 07%）. Median Scr at presentation was （657.80± 423.38） μmol/L, BUN （21.52 ± 11.68） mmol/L, Ua （541.85 ± 243.95）μmol/L. 26. 83% of cases required acute renal replacement therapy. ④78.04% of cases were treated by methypredinisone or predinisone. 1 month later, median Scr decreased to （169.46 ± 96.68） μmol/L,BUN （12. 13 ± 7.81）mmol/L,Ua （312.69 ± 149.67）μmol/L（P d0. 001）all the patients besides one got rid of the dialysis. About 43.9% of patients＇ Scr were totally recovered. ⑤ The patients whose Scr unrecovered totally compared with the patients whose Scr totally recovered, the former had high frequency of glucosurine and more patients had chronic kidney disease before occurred AIN. Both groups had no significant difference on renal histological features. Conclusions The clinical features of AIN are various and drug is the main cause of AIN. Patients who had renal disease before AIN or had glucosurine during the course of disease have worse prognosis.
出处
《复旦学报（医学版）》
CAS
CSCD
北大核心
2006年第5期698-700,703,共4页
Fudan University Journal of Medical Sciences
基金
上海市科委重点基础课题项目(04jc14026)资助
关键词
急性间质性肾炎
急性肾功能衰竭
临床病理分析
acute interstitial nephritis
acute renal failure
clinical and pathology analysis
