53例急性间质性肾炎临床病理分析

Clinicopathological analysis of 53 cases of acute interstitial nephritis

目的 分析急性间质性肾炎（acute interstitial nephr-itis,AIN）的病因、临床表现及肾脏病理改变,探讨联合糖皮质激素治疗AIN的效果及预后.方法 回顾性分析我院自2004年1月至2012年12月经肾活检确诊的53例AIN患者的病因、临床表现、肾脏病理改变及联合糖皮质激素治疗的疗效等.结果 肾活检病例7 965例,确诊为AIN的53例（占0.67%）,其中11例（占20.75%）合并基础肾小球疾病.分析53例AIN的病因,药物相关性急性间质性肾炎（DAIN）32例（占60.38%）,其中抗生素导致的AIN 14例,占DAIN的43.75%.感染导致的AIN 10例（占18.87%）.主要的临床表现包括急性肾衰竭49例（占92.45%）、镜下血尿33例（占62.26%）、贫血31例（占58.49%）、蛋白尿31例（占58.49%）、白细胞尿17例（占32.08%）、发热14例（占26.42%）,少尿14例（占26.42%）、皮疹4例（占7.55%）、关节痛3例（占5.66%）、嗜酸细胞增高2例（占3.77%）.病理表现示肾小管间质水肿伴炎症细胞浸润,肾小管损伤轻重不等,合并有基础肾小球疾病者有肾小球损伤.共有16例（占30.19%）患者行血液透析治疗,除1例患者在肾活检结果出来前死亡外,其余52例患者均予糖皮质激素治疗.治疗好转出院时32例（占60.38%）患者肾功能恢复正常,16例行血液透析治疗的患者10例肾功能好转摆脱透析,5例维持性血液透析治疗,1例死亡.结论 AIN常见的病因为药物和感染,主要临床表现为非少尿性急性肾衰竭、血尿、贫血、蛋白尿等,联合糖皮质激素治疗效果较好.

Objective To identify the cause, clinical feature, renal pathology of acute interstitial nephritis （AIN） and investigate the effect of corticosteroids treatment. Methods Fifty-three cases of AIN in our hospital during the period of January, 2004 to December, 2012 were analyzed about the cause, clinical feature, renal pathology and the effect of corticosteroids treatment. Results There were 53 AIN patients （0. 67%） in all 7 965 biopsies. Eleven cases （20. 75%） were complicated with basic kidney disease. Of 53 cases of AIN, there were 32 cases of DAIN, accounting for 60. 38% （including 14 cases of DAIN caused by antibiotics, accounting for 42. 75%）, and 10 cases of infection-induced AIN, accounting for 18.87 %. The main clinical manifestation included acute renal failure （92. 45%）, microscopic hematuria （62. 26% ）, anemia （58.49%）, （58. 49% ）, leukourine （32. 08% ）, fever （26. 42%）, oliguria （26. 42%）, rashes （7. 55）, and arthralgia （5.66%）. Renal biopsies showed varying degrees of severity of renal tubular injury. Glomeruli injury was found in patients with basic kidney disease. Sixteen patients （30. 19%） were subjected to hemodialysis. Except one dead patient, 52 patients were treated with corticosteroids. Renal function of 32 patients （60. 38%） was completely recovered. Ten patients got rid of hemodialysis, 5 patients continued with hemodialysis, and one patient died. Conclusions The main causes of AIN are drug and infection. The main clinical manifestations include acute nonoliguric renal failure, hematuria, anemia and . Treatment with corticosteroids is effective for AIN.