PDF(Pubmed)
Abstract：
UNASSIGNED: Drug-induced tubulointerstitial injury is a common cause of renal impairment. Since the mechanisms of drug-induced tubular injury are diverse, various treatment approaches are needed according to the pathogenesis. Renal biopsy is indispensable to determine not only the pathological diagnosis, but also the underlying mechanism, and to guide appropriate treatment. Most recently, one of the red yeast supplements has been widely highlighted as a novel cause of tubular damage, mainly in Japan and Asia. However, neither detailed pathological findings nor the mechanism of renal impairment has been sufficiently reported.
UNASSIGNED: Two cases of renal impairment after taking red yeast supplement internally are presented. Both cases showed renal dysfunction with low uric acid, potassium, and phosphorus levels, characteristic features of Fanconi syndrome. The renal biopsy findings of both cases showed severe injury to the proximal tubules with mild inflammatory cell infiltration. The proximal tubules exhibited diffuse loss of the brush border, flattening, and tubular lumen dilation. Immunofluorescence showed no deposition of immunoglobulin and complement in the glomeruli and tubules. Electron microscopic findings indicated proximal tubular damage without crystal deposition. Moreover, immunohistochemistry using the proximal tubular marker CD10 and a marker for distal tubules including the loop of Henle, E-cadherin, collectively demonstrated that the focus of renal injury in both cases was mainly the proximal tubules.
UNASSIGNED: The red yeast rice supplement itself, its metabolized product, or other unknown contaminant components might directly induce proximal tubulopathy rather than an allergic reaction-related tubulointerstitial nephritis.
UNASSIGNED: Two cases of renal impairment after taking red yeast supplement internally are presented. Both cases showed renal dysfunction with low uric acid, potassium, and phosphorus levels, characteristic features of Fanconi syndrome. The renal biopsy findings of both cases showed severe injury to the proximal tubules with mild inflammatory cell infiltration. The proximal tubules exhibited diffuse loss of the brush border, flattening, and tubular lumen dilation. Immunofluorescence showed no deposition of immunoglobulin and complement in the glomeruli and tubules. Electron microscopic findings indicated proximal tubular damage without crystal deposition. Moreover, immunohistochemistry using the proximal tubular marker CD10 and a marker for distal tubules including the loop of Henle, E-cadherin, collectively demonstrated that the focus of renal injury in both cases was mainly the proximal tubules.
UNASSIGNED: The red yeast rice supplement itself, its metabolized product, or other unknown contaminant components might directly induce proximal tubulopathy rather than an allergic reaction-related tubulointerstitial nephritis.
摘要：
■药物诱导的肾小管间质损伤是肾损害的常见原因。由于药物引起的肾小管损伤的机制是多种多样的，根据发病机制需要各种治疗方法。肾活检不仅是病理诊断不可缺少的确定,还有潜在的机制，并指导适当的治疗。最近,其中一种红色酵母补充剂已被广泛强调为肾小管损伤的新原因，主要在日本和亚洲。然而,详细的病理结果和肾功能损害的机制都没有得到充分报道.
■介绍了2例内部服用红曲补充剂后出现肾功能损害的病例。两例均表现为肾功能不全低尿酸,钾，和磷水平，范可尼综合征的特征性特征。两种情况的肾活检结果均显示近端小管严重损伤，并伴有轻度炎症细胞浸润。近端小管表现出刷状边界的弥漫性损失，展平,和管状管腔扩张。免疫荧光显示肾小球和肾小管中没有免疫球蛋白和补体沉积。电子显微镜发现表明近端管状损伤，没有晶体沉积。此外，使用近端肾小管标记CD10和远端肾小管标记包括Henle环的免疫组织化学，E-cadherin,共同证明，在这两种情况下，肾损伤的重点主要是近端小管。
■红曲米补充剂本身，它的代谢产物，或其他未知污染物成分可能直接诱发近端肾小管病变，而不是过敏反应相关的肾小管间质性肾炎。
■介绍了2例内部服用红曲补充剂后出现肾功能损害的病例。两例均表现为肾功能不全低尿酸,钾，和磷水平，范可尼综合征的特征性特征。两种情况的肾活检结果均显示近端小管严重损伤，并伴有轻度炎症细胞浸润。近端小管表现出刷状边界的弥漫性损失，展平,和管状管腔扩张。免疫荧光显示肾小球和肾小管中没有免疫球蛋白和补体沉积。电子显微镜发现表明近端管状损伤，没有晶体沉积。此外，使用近端肾小管标记CD10和远端肾小管标记包括Henle环的免疫组织化学，E-cadherin,共同证明，在这两种情况下，肾损伤的重点主要是近端小管。
■红曲米补充剂本身，它的代谢产物，或其他未知污染物成分可能直接诱发近端肾小管病变，而不是过敏反应相关的肾小管间质性肾炎。
