药物性急性间质性肾炎的病例报告及文献分析

Drug-induced acute interstitial nephritis:case report and literature review

目的:探讨药物相关急性间质性肾炎(drug-induced acute interstitial nephritis,DAIN)的临床特征、危险因素、预防和治疗对策。方法:报道抗菌药物致急性间质性肾炎(acute interstitial nephritis,AIN)的病例,并进行相关文献分析。结果和结论:多种抗菌药物均可导致DAIN,万古霉素是最常见的药物之一。DAIN最典型的临床症状有发热、皮疹、嗜酸性粒细胞增多、尿常规异常和肾功能损伤。DAIN的预防应做到不滥用抗菌药物,减少不必要的联合用药;使用有肾毒性药物时,应定期监测血药浓度和肾功能。治疗原则包括及早诊断、及时停用可疑药物,对于重症病例宜给予糖皮质激素治疗。

Objective：To investigate the clinical characteristics,related risk factors,prevention and treatment strategies of drug-induced acute interstitial nephritis（DAIN）.Methods：A case of DAIN caused by antibacterials was reported and related literature was analyzed.Results and Conclusion：Various kinds of antibacterials can cause DAIN with vancomycin being one of the most common drugs.The most typical clinical symptoms of DAIN are fever,rash,increased level of eosinophilia,abnormal routine in urine examination and renal function impairment.Preventive measures against DAIN include reasonable application of antimicrobials and reduction of unnecessary drug combinations.Regular monitoring of the serum drug concentration and renal function should be made when using nephrotoxic drugs.Treatment strategies include early diagnosis and prompt withdrawl of suspected drugs.Application of glucocorticoid is necessary in severe cases.