Mefenamic acid-induced neutropenia and renal failure in elderly females with hypothyroidism

We report mefenamic acid-induced non-oliguric renal failure and severe neutropenia occurring simultaneously in two elderly females. The neutropenia was due to maturation arrest of the myeloid series in one patient. Both patients were also hypothyroid, but it is not clear whether this was a predisposing factor to the development of these adverse reactions. However, it would seem prudent not to use mefenamic acid in hypothyroid patients until the hypothyroidism has been corrected.     

Mefenamic acid-induced bullous pemphigoid

A 52 year old man developed bullous pemphigoid, Coombs' positive haemolytic anaemia and diarrhoea related to the use of mefenamic acid. Clinical manifestation of the bullous pemphigoid, haemolytic anaemia and diarrhoea resolved following discontinuation of the mefenamic acid. Mefenamic acid should be added to the list of agents that are known to induce bullous pemphigoid.     

特发性间质性肾炎临床病理分析

目的提高对特发性间质性肾炎的认识,了解其临床、病理特点,以避免误漏诊。方法对７例特发性间质性肾炎行肾活检免疫荧光及电镜检查,血肌酐,β２微球蛋白测定并做眼科检查。全部病人用糖皮质激素,部分用环磷酰胺治疗随访半年～５年。结果临床主要表现为非少尿型急性肾功能不全,伴轻度蛋白尿（＜２ｇ／２４ｈ）、镜下血尿及明显的肾小管功能障碍。３例有高γ球蛋白血症,２例合并了眼色素膜炎。肾活检为典型的肾小管间质炎症,而肾小球及肾血管基本正常。５例病人治疗取得较好疗效。结论对临床上无原因的肾功能不全,特别是非少尿型急性肾衰并伴有肾小管功能障碍者,应考虑此病的可能,尽早行肾活检明确诊断,尽早治疗。     

一体化措施逆转狼疮性肾炎肾功能衰竭

目的　观察一体化措施逆转狼疮性肾炎 (LN)肾功能衰竭的效果。方法　首先判断肾功能衰竭的可逆性 ,将具可逆性的 5 3例分两组进行治疗。观察组 2 7例 ,在对基本状态进行动态评估的基础上 ,采取在血液净化方式和技巧、免疫抑制治疗时机与方法、合理中药、免疫支持及对症治疗等方面多因素优化组合的一体化治疗方案 ;对照组 2 6例 ,常规血液透析、强的松标准疗程和环磷酰胺冲击疗法。结果　观察组总有效率高于对照组 ,WBC低下、感染发生率低于对照组 ,追踪观察 ,两年后对照组平均Scr高于观察组 ,两组差异有显著性 (P <0 0 5 )。结论　一体化逆转LN肾功能衰竭在提高疗效、减少副作用、改善远期预后方面 ,优于常规治疗     

慢性马兜铃酸肾病动物模型的建立及其意义

目的探讨建立马兜铃酸引起的大鼠慢性肾间质纤维化动物模型.方法将雌性wistar大鼠分为马兜铃酸组与对照组.马兜铃酸组大鼠腹膜内注射马兜铃酸5mg@kg-1@d-1共16周,开始用药后8、12、16、20、24周分别处死6只大鼠.对照组大鼠(5只)腹膜内注射生理盐水2ml/d,共16周,24周时处死.两组动物处死时分别留取血、尿、肾组织标本,分别作生化、病理(光镜,免疫荧光,电镜)等方面的检查及应用电脑软件测定肾小管-间质面积.结果马兜铃酸组大鼠用药后16、20、24周体重明显低于对照组;用药后16周血尿素氮、血清肌酐明显高于对照组,24周时肾功能损伤进一步加重.光镜检查可见马兜铃酸组大鼠有明显肾小管-间质损伤,16周时肾小管面积明显增加,管腔面积明显小于对照组;24周时出现明显肾小管萎缩,肾小管面积明显缩小,而肾间质面积明显增加,肾间质呈多灶性纤维化.电镜检查16周时肾小管上皮细胞胞质内初级溶酶体、次级溶酶体明显增加,部分肾小管上皮细胞刷状缘消失;20、24周时可见胞质内次级溶酶体和髓样小体堆积.结论建立了慢性马兜铃酸肾病动物模型.马兜铃酸具有慢性肾毒性作用,可引起大鼠慢性肾间质纤维化.     

狼疮性肾炎合并急性肾衰的临床及病理分析

;目的与方法通过对２５例狼疮性肾炎并急性肾衰患者的回顾性分析,探讨其临床、病理特点及治疗措施。结果病人均属狼疮活动状态,肾脏病理改变以Ⅳ型较多见,且预后还与受累脏器的多少及损害程度相关。大剂量甲基强的松龙及环磷酰胺联合冲击治疗,总有效率６０％。结论　狼疮性肾炎并急性肾衰是肾科的危重症,而早期的强有力治疗可望改善预后。     

Acute interstitial nephritis associated with gentamicin and lincomycin therapy.

A case of acute oliguric renal failure following gentamicin and linocomycin therapy is described. Renal biopsy showed an acute interstitial nephritis. This was associated with high serum gentamicin levels and the later development of ototoxicity. Withdrawal of antibiotics and conservative measures was followed by rapid recovery of renal function. Attention is drawn to the association between gentamicin and lincomycin therapy and the development of an acute interstitial nephritis.     

Study on effect of Baoyuan Qiangshen Capsule No. II on tubular interstitial injury in chronic renal failure patientsCapsule No. II on tubular interstitial injury in chronic renal failure patients

Objective: To explore the protective effect of Baoyuan Qiangshen Capsule No. II (BYQS) and its mechanism in treating chronic renal failure (CRF).Methods: Sixty CRF patients were divided into 2 groups randomly, the treated group used BYQS combined with Lotensin and the control group administered with essential amino acid combined with Lotensin. Changes of renal functions and tubular labelled proteins were observed.Results: The markedly effective rate and total effective rate of the treated group were 63.3% and 93.3% respectively, and those of the control group were 30.0% and 56.7% respectively, the effect of the treated group was obviously better than that of the control group (P < 0.01). In the treated group after medication, blood urea nitrogen, serum creatinine and clearance rate of creatinine were improved significantly (P < 0.01), while Tamm-Horfau protein increased significantly (P < 0.01).Conclusion: BYQS could alleviate tubular interstitial injury significantly so as to improve the renal function and enhance the effective rate in treating CRF.     

腹膜透析在狼疮性肾炎急性肾功能衰竭中的应用

目的　探讨在狼疮性肾炎 (LN)急性肾功能衰竭 (ARF)活动性肾损害免疫抑制治疗中 ,腹膜透析的辅助治疗作用。方法　对LN并发ARF的 12例行腹透治疗 ,并行肾活检明确病理 ,根据临床和病理的活动程度 ,予激素和 (或 )免疫抑制剂环磷酰胺 (CTX)冲击治疗。结果　 11/ 12例肾活检成功 ,均为Ⅳ型LN ,主要呈活动性肾损害的病理改变 ,也有慢性不可逆病变。治疗有效率为 5 0 % ,经强化免疫抑制治疗 6例临床指标血红蛋白、C3 、C4、血白蛋白、尿蛋白均显著改善 (P <0 .0 5 ) ,肾功能基本恢复 ;3/ 6例活动性指数 (AI)显著降低 ,慢性指数 (CI)无明显变化。无效组 6例 ,病理慢性程度高 ,并发肾外脏器的损害 ,病情在短期内恶化。对有效组中的 5例长期随访 ,4 / 5例肾活检时AI 10 .8± 2 .8,CI 4 .0± 1.4 ,平均随访 6 .8年 (4～ 11年 ) ,Scr均 <176 .8umol/L ;而 1/ 5例AI 18,CI 5 ,3年后进入尿毒症。结论　LN并ARF ,经腹透治疗 ,活动性肾损害予强化免疫抑制治疗可顿挫其活动病变 ,改善肾功能。而对LN的慢性病变 ,尤其是纤维细胞性新月体和广泛的间质纤维化 ,只能采取保守或腹透维持治疗。     

急性间质性肾炎34例

目的分析急性间质性肾炎（AIN）的病因、临床特点、肾脏病理改变、治疗及转归。方法回顾性分析2007年1月至2010年10月郑州大学第一附属医院经肾活检确诊为AIN患者的病因、临床特点、肾脏病理结果、治疗措施及转归。结果①确诊为AIN患者共34例,其中药物相关性急性间质性肾炎（DAIN）27例,占79．4％,抗生素导致的AIN占DAIN的70．4％,最常见的抗生素依次为β-内酰胺类、氨基糖甙类、喹诺酮类、磺胺类。②临床表现有急性肾功能衰竭（ARF）（100％）、发热（64．7％）、蛋白尿（55．9％）、少尿或无尿（52．9％）、镜下血尿（41．2％）、白细胞尿（38．2％）、皮疹（32．4％）、尿糖（26．5％）及关节痛（14．7％）。⑧病理显示肾小管损伤轻重不等,肾小球及肾血管无明显病变。④18例（52．9％）口服强的松治疗,7例（20．6％）应用甲强龙冲击,7例（20．6％）行血液透析治疗,2例仅给予对症支持治疗;6周后,除2例患者未脱离透析,其他患者均明显好转.入院时患者平均血清尿素氮（BUN）为（19．9±7．3）mmol／L,肌酐（Ser）为（532±237）μmogL,尿酸（UA）为（415±141）μmol／L;治疗6周后,肾功能的各项指标均有明显降低,平均BUN为（7．4±2．7）mol/L,Scr为（133±85）μmol／L,UA为f309±94）μmol／L,与治疗前相比差异有统计学意义（P均〈0．01）,疗效显著。结论AIN的常见致病因素为药物。临床表现呈多样性,无特异性,发热为其最常见的临床表现。临床及病理改变决定治疗措施,激素及血液透析是治疗AIN的有效方法,及时把握时机,并选取恰当的治疗方法是改善预后的关键。     

Drug-induced acute interstitial nephritis: report of 10 cases.

Between January 1979 and June 1985, 10 patients with acute allergic interstitial nephritis were seen in a clinical nephrology service at a large regional hospital. The onset of renal failure was temporally related to the use of a drug: a nonsteroidal anti-inflammatory agent (NSAID) (in four patients), cimetidine (in three), antibiotics (in two) or allopurinol (in one). The onset of renal failure was acute in three patients and insidious in seven. Two patients also exhibited marked proteinuria. Clinical features such as fever, rash, hematuria, pyuria with or without eosinophiluria, and mild to marked proteinuria had led to suspicion of the disease. The diagnosis was confirmed by renal biopsy findings of inflammatory cells, predominantly lymphocytes, plasma cells and eosinophils. Three patients required hemodialysis; two of them received steroids as well. Steroid therapy was also used in two patients with NSAID-induced proteinuria. Renal function improved in nine patients by 35 days, but one patient continued to have slow but progressive deterioration of renal function. Acute interstitial nephritis can be distinguished from other forms of acute renal failure by heavy renal uptake of gallium 67, maximal 48 hours or more after injection. The improvement in renal function after discontinuation of the implicated drug, the characteristic histopathological findings of allergic interstitial nephritis, and the presence of eosinophils and sometimes IgE in the blood suggest a hypersensitivity reaction.