关木通引起慢性间质性肾炎7例报告

目的　观察关木通所致慢性肾损伤的临床和病理改变特点。方法　本组 7例中 ,男 5例 ,女 2例。 3例服关木通汤药 ,4例服含关木通成药。分析服用时间、累积总量与肾损害首发症状及症状出现时间、肾功能和肾病理改变的关系。结果　汤药组 :服药时间平均 3 3 3个月 ,累积总量平均 82 9 3 g ,首发症状为乏力 3例 ,夜尿增多 2例 ,平均时间为 8 3个月 ,Cr平均 40 2 μmol/L。肾病理 :3例均为重度寡细胞性肾间质纤维化 ,肾小管广泛萎缩。成药组 :服药时间平均 7 5个月 ,累积总量平均 13 6g ,乏力 3例 ,夜尿增多 1例 ,恶心呕吐、头痛头晕 1例 ,平均18 8个月 ,Cr 3 62 8μmol/L。肾病理为重度寡细胞性间质纤维化和灶状纤维化各 2例 ,肾小管灶状萎缩 3例 ,广泛萎缩 1例。结论　汤药组关木通积累大 ,发病时间早 ,肾病理改变重。提示关木通所致肾损其临床表现、病理改变与服用关木通时间、剂量相关。

A Report of the Cases of Chronic Interstitial Nephritis Associated with Aristolochia Manshuriensis Kom

Objective To investigate the clinical and renal histological characteristics of renal injury associated with Aristolochia manshuriensis Kom (mutong, MT).Methods Seven patients (five males and two females, 36 to 55 years old) who had taken MT (three ones with decoction drugs, four with patent drugs) were studied. Six patients had underlying kidney diseases prior to the administration of MT. The duration of administration, dose of MT, onset symptoms, renal function and so on were analyzed.Results In the decoction drugs group, the mean drug-administering time was 33.3 months, and the mean dose of MT was 829.3g. The onset symptoms were fatigue (in three patients) and nocturia (in two patients), and their mean occurrence time was 8.3 months. The mean concentration of serum creatine (SCr) was 402μmol/L. All the three patients showed extensive acellular interstitial fibrosis and severe tubular atrophy. In the patent drugs group, the mean drug-administering time was 7.5 months, and the mean dose of MT was 136.0g. The onset symptoms included fatigue (in three patients), nocturia (in one patient), nausea, vomiting, headache and dizziness (in one patient). The mean occurrence time was 18.8 months. The mean concentration of SCr was 362,8μmol/L. Two patients showed extensive acellular interstitial fibrosis, two patients local interstitial fibrosis, three patients local tubular atrophy and one patient extensive tubular atrophy.Conclusion The data suggested that the clinical and renal histological characteristics of renal injury associated with MT are closely correlated with the dose of MT and with the MT-administering duration.