肾小球肾炎合并急性间质性肾炎的临床病理分析

目的 探讨肾小球肾炎合并急性间质性肾炎(AIN)患者的临床和病理特点。 方法 回顾性分析21例经肾活检证实的肾小球肾炎合并AIN患者的资料，以同期无肾小球疾病的AIN患者 35例作为对照。 结果 肾小球肾炎合并AIN占同期AIN的37.5%。β内酰胺类抗生素、中药是引起AIN的主要病因。76.2%的患者就诊原因为发现血肌酐升高。肾组织学检查同时存在肾小球肾炎和AIN的病理改变，肾间质与肾小球病变程度不平行，前者普遍重于肾小球损害，肾间质中嗜酸性粒细胞对诊断有提示价值。随访中，64.7%的患者肾功能最终恢复正常或基线水平，中位恢复时间为150 d（单纯AIN组为60 d），两组患者在2年内肾功能恢复情况方面无明显差异。 结论 肾小球肾炎合并AIN的患者临床表现不典型，AIN的症状易被肾小球肾炎掩盖。肾活检对诊断和鉴别有重要价值。早期诊治的患者预后较好。     

药物性急性间质性肾炎10例临床分析

随着肾活检技术的开展 ,日益增多的药物性急性间质性肾炎 (ＤＡＩＮ)患者得到诊断和挽救。近来 ,我们对一组ＤＡＩＮ进行临床观察 ,旨在加深对本病临床特点的认识。现分析报告如下。资料与方法1　一般资料　 10例均为住院患者。其中男 7例 ,女 3例 ;年龄 17岁～ 5 9岁 ,平均 39.7岁。全部病例均经肾活检确诊。肾穿刺组织同时行光镜、免疫荧光和电镜检查。2　临床表现　所有病例均有近期用药史 ,间歇期 1～31ｄ ,平均 11.6ｄ ,其中 6例发生于用药第 2周。可疑药物 :青霉素类 3例 ,利福平 2例 ,头孢菌素类 1例 ,狂犬病毒疫苗合并庆大霉素 1例 …     

51例儿童急性间质性肾炎临床与病理分析

目的:探讨儿童急性间质性肾炎（acute interstitial nephritis,AIN）的病因、临床表现和肾脏病理特点及其危险因素。方法:回顾性收集解放军东部战区总医院2010年1月至2019年12月经肾穿刺活检术确诊为AIN儿童的病因、临床表现、实验室检查结果、治疗方法和预后等资料。采用Kaplan-Meie...     

四种不同感染所致急性间质性肾炎

目的 探讨系统感染相关性急性间质性肾炎(I—AIN)疾病特点。方法 对布鲁杆菌、EB病毒、汉坦病毒及疟原虫感染引起的I—AIN各1例病情、诊断及治疗进行了详细报道，然后分析疾病共性。结果 I—AIN常在感染后数日至数月发病，至轻度蛋白尿、无菌性白细胞尿或(和)血尿，伴近、远端肾小管功能异常，重症出现急性肾衰竭。病理检查见肾间质淋巴及单核细胞浸润伴水肿，肾小管上皮细胞变性。系统感染控制后I—AIN常能随之好转，投给小剂量类固醉激素有助于疾病恢复。结论 I—AIN是一独立疾病，应提高认识，予以正确诊治。     

药物所致急性间质性肾炎

药物所致急性间质性肾炎(D-AIN)是急性肾衰竭的重要原因。可以引起AIN的药物很多，其中以青霉素类和非甾体类抗炎药最为常见，见表1。其发病机制主要是药物或其代谢产物所致的过敏反应。     

急性间质性肾炎的临床病理分析

急性间质性肾炎（AIN）为一临床病理综合征，起病急。是致急性肾功能衰竭的重要原因。肾脏病理上可见肾间质水肿和炎性细胞浸润。肾小管呈不同程度退行性变。本研究对我院近10年来肾活检确诊的AIN患者病因、临床表现、肾脏病理进行分析，加深临床医生对AIN的认识．籍以提高对AIN的诊治水平。     

间质性肾炎19例临床与病理分析

目的 探讨间质性肾炎的临床与病理特点。方法 回顾分析经肾活检证实的急、慢性间质性肾炎完整病历资料19例。结果 本组19例，急性患者7例；慢性患者12例，病因明确9例（47．4％），主要诱发因素是药物（66．7％）；全部病例中以蛋白尿、浮肿、肾功能不全为主要表现，仅部分患者出现肾小管功能损害的临床表现；其病理特点以肾间质的炎性浸润为主，而肾小球、肾小血管基本正常；本组6例急性肾功能不全患者在血透的基础上加用激素治疗，效果良好。结论 间质性肾炎的临床表现不典型，肾小管间质本身损害的临床表现并不突出，其病理的基本特征为：间质的炎性细胞浸润、水肿或纤维化，肾小球、肾小血管基本正常。     

Prognosis of severe drug-induced acute interstitial nephritis requiring renal replacement therapy

ObjectiveDrug-induced acute interstitial nephritis (DAIN) is often associated with improved outcomes, whereas some patients may still progress to chronic kidney disease (CKD). The aim of this study was to evaluate the prognosis of patients with severe DAIN requiring renal replacement therapy (RRT) at baseline, and to explore the risk factors of progression to CKD.MethodsWe performed a retrospective study of patients with severe DAIN confirmed by renal biopsies in our center over a 10 years period, all the patients received RRT at presentation. The clinical and pathological characteristics at baseline were recorded, and the outcomes (renal function recovered or progressed to CKD) during follow-ups were also evaluated. Univariate and multivariate logistic regression analysis were performed to identify the independent risk factors of progression to CKD.ResultsSeventy-two patients who met the inclusion criteria were enrolled, 13 patients (18.0%) progressed to CKD (GFR < 60 ml/min/1.73 m²) after at least 6 months of follow-up, the remaining 59 patients achieved a favorable renal function recovery. Compared with patients who achieved renal function recovery (recovery group), the patients progressed to CKD (progression group) were older and had longer interval from symptom onset to treatment with steroids. The peak serum cystatin C concentration was higher in progression group than recovery group. Higher score of interstitial fibrosis/tubular atrophy (IFTA) and more interstitial inflammatory cells infiltration were detected in renal tissue in progression group. According to multivariable analysis, higher peak cystatin C concentration (OR = 2.443, 95% CI 1.257, 4.746, p = 0.008), longer interval to treatment with corticosteroids (OR = 1.183, 95% CI 1.035, 1.352, p = 0.014) were independent risk factors of progression to CKD. The cutoff value of cystatin C concentration was 4.34 mg/L, at which the sensitivity and specificity were 76.9% and 89.3%, respectively; the cutoff value of interval to treatment with corticosteroids was 22.5 days, at which the sensitivity and specificity were 81.8% and 79.5%, respectively.ConclusionRenal function was reversible in majority of patients with severe DAIN requiring RRT when early identification and treatment. Higher peak cystatin C concentration and longer interval to treatment with corticosteroids associated with worse renal prognosis.     

Proton pump inhibitors and acute interstitial nephritis: report and analysis of 15 cases

AIM: Although proton pump inhibitors (PPI) are usually safe and effective therapeutic agents, serious adverse effects can occur. The aim of the present study was to report and analyse the clinical features of 15 patients with acute interstitial nephritis (AIN) and acute renal failure from PPI that were referred to renal services in Auckland over a period of 3 years. METHODS: The clinical presentation, therapeutic drugs, demographic details and renal outcome of the patients were considered. The population at risk and total PPI exposure were able to be defined. The diagnosis of AIN was made by renal biopsy in 12 cases. In all patients, the time-course of drug exposure and improvement of renal function on withdrawal suggested PPI were causal. RESULTS: The median patient age was 78 years. The mean baseline serum creatinine level was 83 micromol/L, peak level 392 micromol/L, and recovery level 139 micromol/L. The erythrocyte sedimentation rate (ESR) and C-reactive protein were elevated at the time of diagnosis in the 11 and 12 patients, respectively, where this information was collected (ESR mean 85 mm/h, and C-reactive protein mean 81 mg/L). AIN occurred at 8 per 100 000 patient years (95% confidence level 2.6-18.7 per 100 000 patient years). Although four patients presented with an acute systemic allergic reaction, 11 were asymptomatic with an insidious development of renal failure. CONCLUSION: PPI are now the most commonly identified cause of AIN in the Auckland area. Recovery occurs after withdrawal of the drug but is often incomplete. Early diagnosis may be facilitated by clinician awareness of the insidious onset of renal failure, and an elevated erythrocyte sedimentation rate and C-reactive protein.     

Rabeprazole-induced acute interstitial nephritis

Acute interstitial nephritis is an uncommon but important cause of acute renal failure. Proton pump inhibitors are now thought to be the most common class of drugs implicated in drug-induced acute interstitial nephritis. This is the first reported case of rabeprazole-induced acute interstitial nephritis.     

Phenazopyridine associated acute interstitial nephritis and review of literature

Phenazopyridine is a urinary analgesic; commonly seen side-effects of this drug include, orange discoloration of urine, methemoglobinemia, yellowish skin discoloration, hepatitis and acute renal failure. Various case reports with phenazopyridine associated acute renal failure secondary to acute tubular necrosis have been reported in the literature. Acute kidney injury in these patients is caused by either direct injury to renal tubular epithelial cells or secondary to pigment induced nephropathy from hemolytic anemia. Hypoxic injury from phenazopyridine-induced methemoglobinemia has been well documented. We report a case of biopsy proven acute interstitial nephritis, associated with therapeutic doses of phenazopyridine without any evidence of methemoglobinemia or other mechanism of renal injury. Clinicians should be aware of the toxicity of this commonly used drug and should look closely for signs of renal insufficiency. Identifying and stopping the offending medication stays as the first step, but recent studies indicate that early steroid administration improves renal recovery, as well as decreasing the risk of progression to chronic kidney disease with fibrosis and consequent permanent renal damage.     

Ibrutinib-induced acute kidney injury via interstitial nephritis

The introduction of Bruton''s tyrosine kinase inhibitor ibrutinib has made a significant progress in the treatment of chronic lymphocytic leukemia and other B-cell malignancies. Due to the reduction of cytokine release, it is effective in chronic graft-versus-host disease, and its use has also been suggested in autoimmune diseases and in prevention of COVID-19-associated lung damage. Despite this effect on the immune response, we report a severe hypersensitivity reaction in a 76-year-old male patient diagnosed with prolymphocytic leukemia. Four weeks after the ibrutinib start, non-oliguric acute kidney injury with proteinuria and microscopic hematuria developed and that was accompanied by lower limb purpuras and paresthesia. Renal biopsy revealed acute interstitial nephritis. Employing 1 mg/kg methylprednisolone administration, serum creatinine decreased from 365 μmol/L to 125 μmol/L at 11 days and the proteinuria-hematuria as well as the purpura, paresthesia resolved. Three months later at stabile eGFR of 56 ml/min/1.73 m² methylprednisolone was withdrawn and a rituximab-venetoclax treatment was initiated without side effects. We conclude that despite the beneficial effect on cytokines response in Th1 direction, ibrutinib can cause acute interstitial nephritis. Early detection, discontinuation of ibrutinib, glucocorticoid administration may help to better preserve renal function, thereby lowering the risk of potential subsequent kidney injury.     

A syndrome of acute interstitial nephritis and anterior uveitis

A syndrome of acute interstitial nephritis (AIN) and anterior uveitis is described in two children and the literature is reviewed. These disorders appear to improve, in uncontrolled studies, with systemic and topical ophthalmic corticosteroid treatment. Although the renal and ocular prognoses appear good, it is important to recotnize that patients with AIN are at risk for uveitis and if present, consultation with an ophthalmologist is recommended.     

药物性急性间质性肾炎的临床及病理研究

目的 了解药物性急性间质肾炎(D-AIN)的临床及病理特点,以求提高诊治水平。方法 分析14例D-AIN的临床表现及肾脏病理、免疫病理特征,并用药物淋巴细胞转化试验辅助诊断致病药物。结果 D-AIN临床表现多样,缺乏特征性;肾活检是确诊的主要手段。结论 药物特异性淋巴细胞转化试验有助于明确致病的过敏药物。     

Antibiotic-induced recurring interstitial nephritis

Acute interstitial nephritis (AIN) is often induced by drug therapy and accounts for 1%–3% of adult cases of renal failure. A 13-year-old white female with cystic fibrosis developed two episodes of biopsy proven AIN following antibiotic use over a 5-year period. The first episode resolved with pulse steroid therapy and the second resolved without intervention. Steroid therapy may play a role in aborting subsequent AIN attacks. Received: 22 January 2001 / Revised: 19 June 2001 / Accepted: 19 June 2001