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。

Clinicopathological analysis on glomerulonephritis complicating with acute interstitial nephritis

Objective To identify the clinical characteristics and pathological changes of patients suffered from glomerulonephritis complicating with acute interstitial nephritis (AIN) . Methods Twenty one patients of glomerulonephritis complicating with AIN diagnosed by renal biopsy were retrospectively analyzed . Thirty-five pure AIN patients were selected as controls .Results Glomerulonephritis complicating AIN accounted for 37 .5% of all the AIN cases . Βlactam antibiotics and Chinese herbs were the major causes of AIN . 76 .2% of cases received further examinations due to the elevation of serum creatinine (Scr) during their follow-up of kidney injuries or during routine exams for all kinds of discomforts . Pathological features of AIN were also detected besides glomerular leisions . The impairments of renal interstitia were severe than those of the glomeruli . Eosinophil in the renal interstitia was an important indicator for the diagnosis of AIN .The renal function returned to normal or baseline in 64 .7% of the patients of glomerulonephritis complicating with AIN whose follow-up data were available . The median period for renal function restoration was 150 days (compared with 60 days in pure AIN) . But there were no significant differences between these two groups as for the rate of irreversible renal insufficiency during a follow-up period of 2 years . Conclusions Symptoms of AIN in patients of glomerulonephritis complicating with AIN tend to be masked by their glomerular diseases . Renal biopsy is of most importance for the diagnosis . Early diagnosis and treatment leads to satisfactory prognosis .