莫西沙星和左氧氟沙星致急性肾小管间质肾病

Acute interstitial nephritis caused by moxifloxacin and levofloxacin

1例31岁男性患者因呼吸道感染给予莫西沙星0.4 g、1次/d口服，用药3 d病情无改善并出现尿量减少；换用左氧氟沙星0.2 g、2次/d口服，用药8 d 病情仍无明显好转，且出现尿蛋白（＋）， 5～10个红细胞/HP， 3～5个白细胞/HP， Scr 419 μmol/L。肾活检示急性肾小管间质肾病。考虑可能为莫西沙星和左氧氟沙星引起的急性间质性肾炎。停用左氧氟沙星，给予甲泼尼龙 250 mg、1次/d静脉滴注；3 d后改为泼尼松40 mg、1次/d口服。治疗7 d后患者Scr降至168 μmol/L，尿素13.6 mmol/L，eGFR 45.8 ml·min^-1·1.73 m^-2。2个月后复查，患者Scr 119 μmol/L，尿素6.2 mmol/L。

A 31-year-old male patient received an oral moxifloxacin 0.4 g once daily for respiratory infection and after 3 days of treatment, his symptoms were not improved and appeared urine decrease. Moxifloxacin was stopped and changed into levofloxacin 0.2 g twice daily by mouth. After 8 days of treatment, the patient′s symptoms was not improved apparently and appeared urinary protein（＋）, 5-10 erythrocytes/high magnification （HP）, 3-5 white blood cells/HP, serum creatinine 419 μmol/L. Renal biopsy showed acute tubular interstitial nephropathy. Drug-induced acute interstitial nephritis-induced by moxifloxacin and levofloxacin was considered. Levofloxacin was stopped and an IV infusion of methylpred-nisolone 250 mg once daily was given, and 3 days later, it was changed into oral prednison 40 mg once daily. After 7 days of treatment, the patient′s blood creatinine was 168 mol/L, urea 13.6 mmol/L, glomerular filtration rate 45.8 ml/min/1.73 m^2. The patient got better and was discharged. At 2 months of follow up, the patient′s blood creatinine was 119 μmol/L and urea was 6.2 mmol/L.