Abstract：
Glyphosate is a widely used herbicide that is generally considered safe; however, acute kidney injury (AKI) caused by glyphosate ingestion can be severe and require hemodialysis. We present a unique case of a 68-year-old Japanese man who developed AKI after accidental ingestion of glyphosate and required hemodialysis. Based on the clinical presentation and findings, the patient was diagnosed with renal AKI with severe tubulointerstitial damage. However, the precise pathogenesis of the tubulointerstitial damage remained unclear. An elevated beta-2 microglobulin level discovered by the urinalysis during admission raised the suspicion of tubulointerstitial nephritis caused by glyphosate. Gallium scintigraphy revealed accumulation in both kidneys. A renal biopsy revealed acute tubulointerstitial nephritis rather than acute tubular necrosis, which is commonly observed with glyphosate-induced renal injury. After initiating steroid therapy, his kidney function gradually improved and he was weaned from hemodialysis. This report is the first to describe glyphosate-induced acute tubulointerstitial nephritis that was successfully treated with immunosuppressive therapy. Furthermore, this report highlights the importance of steroid therapy for cases of persistent kidney injury after the discontinuation of agents associated with acute tubulointerstitial nephritis.
摘要：
草甘膦是一种广泛使用的除草剂，通常被认为是安全的;然而，摄入草甘膦引起的急性肾损伤（AKI）可能很严重，需要进行血液透析。我们介绍了一个68岁的日本男子的独特案例，该男子在意外摄入草甘膦并需要进行血液透析后患上了AKI。根据临床表现和发现，患者被诊断为肾AKI伴严重肾小管间质损伤.然而,肾小管间质损伤的确切发病机制仍不清楚。入院时尿液分析发现β-2微球蛋白水平升高，怀疑草甘膦引起的肾小管间质性肾炎。镓闪烁显像显示两个肾脏都有积聚。肾活检显示急性肾小管间质性肾炎而不是急性肾小管坏死，这是常见的草甘膦诱导的肾损伤。开始类固醇治疗后，他的肾功能逐渐改善，并从血液透析中断奶。该报告首次描述了草甘膦诱导的急性肾小管间质性肾炎，该肾炎已通过免疫抑制疗法成功治疗。此外，本报告强调了类固醇治疗对急性肾小管间质性肾炎相关药物停药后持续性肾损伤病例的重要性.
