氟喹诺酮类药物所致急性间质性肾炎临床分析

Clinical analysis of fluoroquinolone-induced acute interstitial nephritis

目的:探讨氟喹诺酮类药物致急性间质性肾炎(AIN)的临床特点与治疗方法。方法:收集2002年1月至2010年9月在北京大学第一医院肾脏内科明确诊断为氟喹诺酮类药物所致AIN患者的临床资料进行回顾性分析。记录患者的一般情况、氟喹诺酮类药物应用情况、合并用药情况、实验室检查、肾脏病理学检查结果及随访情况。结果:共5例患者纳入研究。男性3例,女性2例,平均年龄(49±6)岁。分别因泌尿系感染(3例)和发热(2例)应用左氧氟沙星(4例)和培氟沙星(1例),疗程1～12d。从用药至血清肌酐升高的时间为7～15d,平均(11±3)d。5例患者分别出现恶心、呕吐、充血性皮疹、发热、寒战等症状。实验室检查示,5例患者在治疗后12～60d出现血清肌酐和尿蛋白水平升高以及不同程度的尿酸化功能异常,并伴血尿(4例)、肾性糖尿(4例)、尿α1-微球蛋白升高(3例)及无菌性白细胞尿(2例)。停药后1～2d内患者临床症状消失,但血清肌酐、尿常规、尿沉渣及尿酸化功能未恢复正常。5例患者在接受糖皮质激素治疗1～6周后血清肌酐均恢复至正常水平,尿蛋白水平下降,血尿、肾性糖尿和无菌性白细胞尿消失,但部分患者尿α1-微球蛋白及尿酸化功能仍异常。结论:氟喹诺酮类药物所致急性间质性肾炎临床表现缺乏特异性;用药期间应定期做血、尿常规及肾功能检查,一旦出现急性间质性肾炎应及时停药,并可用糖皮质激素治疗。

Objective：To investigate the clinical characteristics and treatment of fluoroquinolone-induced acute interstitial nephritis.Methods：Clinical data on patients who were definitely diagnosed as having fluoroquinolone-induced acute interstitial nephritis in Department of Medicine and Institute of Nephrology,Peking University First Hospital between January 2002 and September 2010 were collected and retrospectively analyzed.The baseline characteristics,fluoroquinolone usage,combined therapy,laboratory tests,pathological examination of the kidney,and follow-up were recorded.Results：Five patients[3 males and 2 females with average age of（48.6±6.1） years]were enrolled in the study.Of them,3 patients received levofloxacin and 2 received pefloxacin for urinary infections or fever.The duration of the treatment was 1 to 12 days.The time to onset of an elevated serum creatinine level after drug administration was 7 to 15 days[average（11±3） days].The patients developed nausea,vomiting,congestive rash,fever,and chills.Laboratory tests showed that 12-60 days after treatment start,the 5 patients developed elevated serum creatinine and urine protein levels,and abnormal urine acidification capability in varying degrees,accompanied by haematuria（4 cases）,renal glycosuria （4 cases）,elevated urinaryα1-MG level（3 cases）,and aseptic leukocyturia（2 cases）.Clinical symptoms disappeared 1 to 2 days after drug withdrawal,but serum creatinine levels,routine urine test results,microscopic examination of urinary sediment,and urine acidification capability did not return to normal.After 1 to 6 weeks of glucocorticoid therapy,serum creatinine levels returned to the normal ranges,urine protein levels decreased,and haematuria,glycosuria and aseptic leukocyturia disappeared,but urinaryα1-MG and urine acidification capability in some patients remained abnormal.Conclusion：The clinical presentation of fluoroquinolone-induced acute interstitial nephritis is lack of specificity.Routine blood and urine tests and kidney function test should be performed regularly during the period of fluoroquinolone therapy.If acute interstitial nephritis occurs,the drug should be discontinued immediately,and glucocorticoid therapy might be given.