Korean Journal of Nephrology 1994;13(1):91-99.

약물에 의한 급성 과민성 간질성 신염의 임상상

신영태 , 빈기태 , 김성숙 , 정민수 , 이순구 , 이강욱 , 서광선

Abstract

Acute hypersensitivity interstitial nephritis is characterized by the sudden onset of clinical signs of renal dysfunction associated with a prominent inflammatory cell infiltrates within the renal interstitium without major glomerular and vascular lesions. We evaluated the clinical findings of 8 patients with drug-induced acute hypersensitivity interstitial nephritis confirmed by renal biopsy in Chungnam National University Hospital from JAN. 1991 to JUN. 1993. The results were as follows. 1) The patients consisited of two males and six females and their ages ranged from 30 to 76 years (mean age 53 years). 2) All patients had history of recent drug treatments such as nonsteroidal anti-inflammatory drugs (NSAIDs), cephalosporin, ampicillin, ciprobay, gentamicin and herb medication. Most prevalent causative drugs were nonsteroidal anti-inflammatory drugs. 3) Peak serum levels of the patients' blood urea nitro gen (BUN) and serum creatinine ranged from 19 to 121 mg/dl (mean 65±36mg/dl) and from 1.7 to 11.1 mg/dl (mean 14.4±12.1 mg/min) and amounts of 24-hour urine protein excretion ranged from 0.2 to 3.1 g/day (mean l. 20.9 mg/day). With 1 exception, all patients showed nonoliguric renal failure. 4) Blood eosionophile count was elevated in three (37. 5%) patients. 5) "GA-citrate scintigrams were performed in 3 patients and renal uptake of "Ga was markly increased (Grade 4) in 1 patients and minimal (grade 2) in 2 cases. 6) Common renal histologic findings in patients were mainly mononuclear inflammatory cell infiltration, interstial edema and renal tubular atrophy with or without eosinophile infiltration. Immunofluorescent studies were normal in all patients and electron micro- scopic studies were also negative except epithelial foot process fusion in 3 patients. 7) All eight patients were managed with removal of the suspected iniciating drugs. Four patients were treat- ed with corticosteroid and other 4 patients had suppor- tive care only. Renal functions were improved in seven patients until 6 month after initial diagnosis. However, one patient showed sustained mild azotemia until 6 months. We thought that acute hypersensitivity interstitial nephritis shoule be considered as one of the main causes of unexplained acute renal failure.