利福平致急性肾功能衰竭的临床病理特点及其机制初探

Clinico-pathological features and possible pathogenesis of rifampicin-induced acute renal failure

目的 初步探讨利福平引起急性肾功能衰竭的临床病理特点及其可能的发病机理。方法 对 4例因应用利福平或主要含利福平成份药物所致的急性肾功能衰竭病人的临床特点、肾脏病理特征进行分析 ,并采用血清学抗人球蛋白试验方法检测病人的抗利福平抗体类型。结果 利福平引起急性肾衰病例占同期住院急性肾衰的 1.98%。 4例病人均有前驱感染史 ,临床主要表现为 (尤其是再次用药后出现 )发热、乏力、胃肠道症状 ,短期内出现少尿或无尿 ,化验可见溶血性贫血、血小板减低及肾功能损害 ,部分伴有肝功能损害。肾活检 3例为急性肾小管坏死 ,1例为急性间质性肾炎。4例的血清抗利福平抗体检测均为阳性。结论 利福平引起的急性肾衰临床并不少见 ,尤其常见于再次用药的病人 ,对此类病人在用药过程中应加强对肾功能的监测 。

Objective To explore the clinico pathological features and possible pathogenesis of rifampicin associated acute renal failure(ARF). Methods The clinico pathological features of 4 patients with Rifampicin associated ARF were analyzed. Rifampicin dependent antibody in the patient′s serum was detected with Coomb′s test. Results 4 cases with rifampicin associated ARF was distinguished from 202 in patients with ARF in 5 years(1.98%). Most of them had infection before the occurrence of ARF. Clinical features were characterized by fever, fatique and gastro intestinal symptoms after taking refampicin(especially when it was reused). Oliguria or anuria developed suddenly. Laboratory data showed hemolytic anemia, thromocytopenia and decline of renal function. Some also had impaired liver function. Renal biopsy revealed acute tubular necrosis in 3 cases and acute interstitial nephritis in 1 case. Serum rifampicin dependent antibody was positive in all the cases. Conclusion Rifampicin associated ARF is not rare clinically, especially in those rifampicin re exposure patients. Renal function should be closely monitored in susceptible patients. Detection of serum rifampicin dependent antibody may be helpful to distinguish this group of ARF patients.