药物致急性间质性肾炎的临床及病理特征

Clinical and pathological features of drug induced acute interstitial nephritis

目的观察药物相关性急性间质性肾炎(DAIN)患者的临床及病理特征。方法选取2003年1月至2009年12月经我院肾活检诊断为急性间质性肾炎的患者72例。根据病程分为急性恢复组(肌酐在3个月之内即恢复至正常水平)和慢性化组(超过3个月肌酐未恢复至正常)。比较2组患者临床及病理特点。结果抗生素是DAIN最常见的因素,其次为非甾体类抗炎药。大多数患者以消化道症状为主诉。慢性化组和急性恢复组在起病时肌酐、病因及临床表现上差异无统计学意义,但慢性化组发病年龄较大(48.8岁对40.6岁,P=0.009),视黄醇结合蛋白(RBP)明显升高[(32.2±19.6)mg/L对(17.1±14.9)mg/L,P<0.01],开始就诊时间明显长于恢复组(34.7 d对14.5 d,P<0.001)。病理上小管病变未见明显差异,但慢性化组间质弥漫细胞浸润的发生率明显大于恢复组。结论抗生素是DAIN最常见病因。发病年龄越大、间质浸润细胞多,易演变为慢性化,预后相对越差。故对年龄较大的急性间质性肾炎患者应更早更积极进行干预治疗。

Objective To investigate the clinical and pathological features of drug-induced acute interstitial nephritis （DAIN）. Methods Seventy-two patients with DAIN（ confirmed by biopsy from January 2003 to Decem- ber 2009）were divided into two groups. Croup 1 ：serum creatinine （Scr） level dropped to the baseline within 3 months ; Group 2 ： renal dysfunction continued for more than 3 months. Clinical and pathological features were com- pared between the two groups. Results Antibiotics （61.1% ） were the main cause of DAIN, followed by the NSAIDs （22.2%）. Most patients had alimentary symptbms. The average age of patients was much higher in group 2. Patients in group 1 presented with more oliguria and less asymptom compared with those in group 2. As for the pathology, more severe renal interstitial inflammatory cell infiltrations were observed in group 2. Conclusion An- tiboitics are the main offending drugs causing DAIN. Elder age and the renal interstitial inflammatory cell infiltra- tion can lead to delayed renal function recovery and chronic interstitial nephritis.