PDF(Pubmed)
Abstract：
Acute interstitial nephritis (AIN) is characterized by an inflammatory infiltrate of the interstitium of the kidney, typically causing a decline in kidney function. Drug-induced AIN (also called allergic AIN) is a type of AIN. Common drugs associated with AIN are antibiotics, non-steroidal anti-inflammatory drugs (NSAIDs), and proton pump inhibitors (PPIs). A 59-year-old male with a history of recent laparoscopic robotic sleeve gastrectomy presented to the emergency department with five weeks of progressively worsening fatigue, nausea, and lightheadedness. Postoperatively, he was prescribed omeprazole 20 mg daily for gastric ulcer prophylaxis. His other home medications were amlodipine, atorvastatin, ursodiol, and budesonide-formoterol fumarate nebulizer. His physical examination was normal. Laboratory studies revealed elevated creatinine of 4.19 mg/dL from a baseline of 0.9 mg/dL two months ago and the presence of urine eosinophils. The etiology of this elevated creatinine was unclear, prompting CT-guided left renal biopsy. The biopsy showed diffuse interstitial inflammatory infiltration with numerous lymphocytes, a large number of neutrophils, and scattered eosinophils, consistent with the allergic type of AIN. Omeprazole was discontinued and the patient received a seven-day course of prednisone. Despite treatment, permanent renal damage occurred, and the patient\'s new baseline creatinine was 2.3 mg/dL. AIN caused by PPIs should be considered in the differential diagnosis of acute kidney injury (AKI). AIN can be difficult to diagnose, presenting with nonspecific symptoms, such as oliguria, malaise, nausea, and vomiting. An accurate and timely diagnosis can help prevent and treat worsening renal failure.
摘要：
急性间质性肾炎（AIN）的特征是肾脏间质的炎症浸润，通常导致肾功能下降。药物诱导的AIN(也称为过敏性AIN)是一种类型的AIN。与AIN相关的常见药物是抗生素，非甾体抗炎药（NSAIDs），和质子泵抑制剂（PPI）。一名59岁的男性，最近有腹腔镜机器人袖状胃切除术的历史，出现在急诊科，疲劳逐渐恶化五周，恶心,和头晕。术后,他每天服用20mg奥美拉唑用于预防胃溃疡.他的其他家庭药物是氨氯地平，阿托伐他汀,熊果二醇,和布地奈德-富马酸福莫特罗雾化器。他的身体检查是正常的。实验室研究显示，肌酐从两个月前的基线0.9mg/dL升高至4.19mg/dL，并且存在尿液嗜酸性粒细胞。肌酐升高的病因尚不清楚，提示CT引导下左肾活检。活检显示弥漫性间质炎性浸润有大量淋巴细胞，大量的中性粒细胞，和分散的嗜酸性粒细胞，与AIN的过敏类型一致。停用奥美拉唑，患者接受为期7天的强的松治疗。尽管治疗,发生永久性肾损害，患者的新基线肌酐为2.3mg/dL。在急性肾损伤（AKI）的鉴别诊断中应考虑PPI引起的AIN。AIN可能很难诊断，表现出非特异性症状，如少尿，萎靡不振,恶心,和呕吐。准确及时的诊断可以帮助预防和治疗恶化的肾衰竭。
