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作者报告1例急性间质性肾炎,其临床特点为:血清 IgG、IgM、IgE 浓度升高,嗜酸细胞增多,以及肾小管有 IgE 沉积。患者女性,54岁,因贫血入院。入院前18个月左右患结肠憩室炎便血而给予复方樟脑酊、白陶土和果胶联合治疗;此后渐感疲劳,健康状况不断恶化,体重减少11.25kg,呼吸困难,有时恶心呕吐,颜面和踝部水肿,否认有变态反应疾患或肾脏病史。除维生素、止泻剂、铁剂及偶尔用过镇静剂外,无服用其他药物史。病者处于昏睡状态,血压正常。BUN136mg/dl,血清肌酐29.6mg/dl,嗜酸细胞18％(计数高达2,506/mm~3),尿蛋白2.3g/24b,抗链球菌试验阴性,肾盂逆行造影正常,尿、血培养持续阴性。免疫学检查:血清 IgG1,733mg/dl、IgM160mg/dl 和IgE264mg/ml 均升高。肾组织活检经普通显微镜、免疫荧光和电子显微镜检查,可见肾间质增宽、水肿、淋巴细胞、浆细胞和嗜酸细胞浸润,邻近区域近曲小管退化,肾小球结构不清,并可明显地观察到 IgE 和C_3在近曲小管内皮呈颗粒状沉积。患者严重肾功能衰竭需作血液透析治疗。8个月后复查血清 IgG、IgM和 IgE 仍继续升高。
The authors report 1 case of acute interstitial nephritis with clinical features of elevated serum IgG, IgM, IgE concentrations, eosinophilia, and tubular deposition of IgE. Female patient, 54 years old, hospitalized for anemia. About 18 months before admission suffering from colic diverticulitis, hematochezia and given compound camphor tincture, kaolin and pectin combined treatment; thereafter gradually tired, the deteriorating health status, weight loss 11.25kg, dyspnea, sometimes nausea, vomiting, face and ankle Department of edema, denied a history of allergic disorders or kidney disease. In addition to vitamins, antidiarrheal agents, iron and occasionally used sedatives, no other medication history. The patient is in a lethargic condition with normal blood pressure. BUN136mg / dl, serum creatinine 29.6mg / dl, eosinophils 18% (count up to 2,506 / mm ~ 3), urinary protein 2.3g / 24b, anti-streptococcal test negative, retrograde retrograde angiography, urine, blood culture continued negative . Immunological examination: Serum IgG1, 733mg / dl, IgM160mg / dl and IgE264mg / ml were elevated. Kidney biopsy by ordinary microscope, immunofluorescence and electron microscopy, showing renal interstitial broadening, edema, lymphocytes, plasma cells and eosinophilic infiltration, near the proximal tubule degeneration, unclear glomerular structure, and It was clearly observed that IgE and C_3 deposited granularly on the proximal tubule endothelium. Serious renal failure patients need hemodialysis treatment. After 8 months, serum IgG, IgM and IgE still continue to rise.