儿童急性间质性肾炎87例临床与病理分析

Clinical and pathological features of 87 cases of acute interstitial nephritis in children

目的:了解儿童急性间质性肾炎(AIN)的病因、临床表现、肾脏病理及治疗转归。方法:回顾性分析10年内我院急性间质性肾炎87例的临床及病理特点。结果:病因方面,感染性疾病占64例(73.6%),以呼吸道及消化道感染最多见,而非感染性疾病23例(26.4%),以手术后及蜂毒等理化因素为主;87例患儿中药物所致55例(60.9%),其中主要为解热镇痛药和抗生素类药(部分因感染后使用);病原学方面,87例病例共检出病毒抗体(血IgM阳性)35例(40.2%),其中以EBV最常见。尿常规检查87例均有改变,蛋白尿、血尿和白细胞尿常见,合并急性肾功能衰竭(ARF)31例(35.6%)。11例行肾穿刺活检确诊,以中重度小管间质病变为特点,3例伴新月体形成。因ARF行血液净化(血液透析或血液滤过)治疗12例共28人次,行腹膜透析1人,仅3例使用小剂量糖皮质激素,肾功能均在短期内恢复正常。结论:儿童AIN发病原因以感染和药物最常见,临床表现以尿常规改变为主,重者出现急性肾功能衰竭等多脏器功能损伤。肾脏病理以小管间质病变为主。预防感染,合理用药是预防AIN发生的关键。

Objective：To analyze the etiology,clinical manifestations,pathology and prognosis of 87 cases of acute interstitial nephritis in children, Methods：Clinical features and pathological data of 87 patients with AIN admitted in our hospital from October 1996 to October 2006 were retrospectively analyzed, Results：Of total 87 cases, 64 were infection-associated（73.6%）, and respiratory and intestinal infections were most common. The other 23 cases（26,4%） were caused by surgery and other reasons. Renal impairment in 55 cases（60.9%）was medication-associated,especially NSAID and antimicrobials. A total of 35 cases（d0.2% ）were virus-associated（IgM positive in blood）,and among those,EBV was the most common one. Clinical manifestations for all cases were variable ranging from mild proteinuria, hematuria and leucocyturia to accomparied acute renal failure（31/87,35.6%）. Renal biopsy was performed in 11 patients. Mononuclear cell infiltration in the renal interstitium with tubular degradation was typical. Crescent was seen in 3 cases. A total of 12 cases（28 person-time） with ARF needed blood puritication（hemodialysis or hemofiltration）, 1 case was treated with peritoneal dialysis. A majority of patients with ARF had complete recovery,and only 3 of them were treated with steroid in low dosage. Concision：Infection and drug associated AIN are common in children. Clinical manifestations are variably ranged,mainly with the change of urine,and the extreme situation is with ARF or multiple organ failure（MOF）. Interstitial and tubular damage is typical in pathology. Prevention of infections and reasonable drug administration are keys to the prevention of AIN in children.