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患者88岁,女性,患慢性肾盂肾炎。1970年首次发现氮质血症;尿检查示脓尿,尿培养有Citrobacter diversus等细菌生长。除1975年作短暂透析外,采用保守治疗。近1年半中,肾功能稳定,尿素氮40～50mg/dl,血清肌酐4～5 mg/dl,平均肌酐清除率10～15ml/min,无少尿(1～2 L/日),血压正常,无须作透析。为研究消炎痛对肾素-醛固酮轴的作用,给予消炎痛口服,每日3次,每次50mg。治疗5天后,尿素氮升至111mg/dl,肌酐7.3mg/dl,出现少尿(<300 ml/24h)及代谢性酸中毒,肌酐清除率降至4.2 ml/min。停用消炎痛,但肾功能仍不良,10日后需作1次血液透析治疗,肾功能渐恢复,17日后肾功能回复消炎痛治疗前的水平。患者尿前列腺素E_2(PGE_2)水平治疗前为521ng/24h,服消炎痛后第3天与第5天,分别为78 ng/24h与79ng/24h,肌酐
Patient 88 years old, female, suffering from chronic pyelonephritis. The first discovery of azotemia in 1970; Urine examination showed pyuria, urine culture with bacteria such as Citrobacter diversus growth. In addition to short-term dialysis in 1975, the use of conservative treatment. Nearly a year and a half, the renal function is stable, urea nitrogen 40 ~ 50mg / dl, serum creatinine 4 ~ 5 mg / dl, average creatinine clearance rate 10 ~ 15ml / min, no oliguria (1-2L / day) Normal, no need for dialysis. To study the effect of indomethacin on the renin-aldosterone axis, indomethacin was given orally 3 times daily for 50 mg each. After 5 days of treatment, urea nitrogen rose to 111mg / dl, creatinine 7.3mg / dl, oliguria (<300 ml / 24h) and metabolic acidosis, creatinine clearance decreased to 4.2 ml / min. Indomethacin was discontinued, but renal function was still poor. Hemodialysis was required after 10 days. The renal function recovered gradually and the level of renal function before treatment of indomethacin was restored after 17 days. The level of prostaglandin E_2 (PGE_2) was 521ng / 24h before treatment and 78 ng / 24h and 79ng / 24h on the 3rd and 5th day after administration of indomethacin, creatinine