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目的:探讨氟喹诺酮类药物致急性间质性肾炎(AIN)的临床特点与治疗方法。方法:收集2002年1月至2010年9月在北京大学第一医院肾脏内科明确诊断为氟喹诺酮类药物所致AIN患者的临床资料进行回顾性分析。记录患者的一般情况、氟喹诺酮类药物应用情况、合并用药情况、实验室检查、肾脏病理学检查结果及随访情况。结果:共5例患者纳入研究。男性3例,女性2例,平均年龄(49±6)岁。分别因泌尿系感染(3例)和发热(2例)应用左氧氟沙星(4例)和培氟沙星(1例),疗程1～12d。从用药至血清肌酐升高的时间为7～15d,平均(11±3)d。5例患者分别出现恶心、呕吐、充血性皮疹、发热、寒战等症状。实验室检查示,5例患者在治疗后12～60d出现血清肌酐和尿蛋白水平升高以及不同程度的尿酸化功能异常,并伴血尿(4例)、肾性糖尿(4例)、尿α1-微球蛋白升高(3例)及无菌性白细胞尿(2例)。停药后1～2d内患者临床症状消失,但血清肌酐、尿常规、尿沉渣及尿酸化功能未恢复正常。5例患者在接受糖皮质激素治疗1～6周后血清肌酐均恢复至正常水平,尿蛋白水平下降,血尿、肾性糖尿和无菌性白细胞尿消失,但部分患者尿α1-微球蛋白及尿酸化功能仍异常。结论:氟喹诺酮类药物所致急性间质性肾炎临床表现缺乏特异性;用药期间应定期做血、尿常规及肾功能检查,一旦出现急性间质性肾炎应及时停药,并可用糖皮质激素治疗。
Objective: To investigate the clinical features and treatment of fluoroquinolone-induced acute interstitial nephritis (AIN). Methods: A retrospective analysis was performed on the clinical data of AIN patients diagnosed as fluoroquinolones in the Department of Nephrology, Peking University First Hospital from January 2002 to September 2010. Record the general situation of patients, the application of fluoroquinolones, combined medication, laboratory tests, renal pathological findings and follow-up. RESULTS: A total of 5 patients were included in the study. There were 3 males and 2 females with an average age of 49 ± 6 years. Levofloxacin (4 cases) and pefloxacin (1 case) were applied for urinary tract infection (3 cases) and fever (2 cases), respectively, for 1 to 12 days. From medication to serum creatinine increased for 7 ~ 15d, an average of (11 ± 3) d. Five patients were nausea, vomiting, congestive rashes, fever, chills and other symptoms. Laboratory tests showed that serum creatinine and urinary protein levels were elevated in 5 patients 12 to 60 days after treatment, with varying degrees of abnormal uric acid function, with hematuria (4 cases), renal diabetes (4 cases), urinary α1 - Microglobulin increased (3 cases) and aseptic leukocytosis (2 cases). Clinical symptoms disappeared within 1-2 days after discontinuation, but serum creatinine, urine routine, urine sediment and uric acid function did not return to normal. Serum creatinine returned to normal level in 5 patients after receiving glucocorticoid treatment for 1 to 6 weeks, urinary protein level decreased, hematuria, renal diabetes and aseptic leucocyturia disappeared, but some patients urinary α1-microglobulin and Uric acid function is still abnormal. Conclusion: Fluoroquinolones-induced acute interstitial nephritis clinical manifestations of the lack of specificity; medication should be regularly done blood, urine and renal function tests, in the event of acute interstitial nephritis should be promptly discontinued, and glucocorticoid treatment.