199例儿童急性间质性肾炎临床及预后分析

Clinical and prognostic analysis of 199 children with acute interstitial nephritis

摘要:

目 的：分析急性间质性肾炎(acute interstitial nephritis, AIN)的临床特点、病理改变及治疗转归情况,提高对AIN的认识和临床诊治水平,减少急性肾损伤发生。方 法：回顾性分析2010年1月至2017年12月我院肾内科收治的199例AIN患儿的病因、临床特点、辅助检查及治疗转归情况。结 果：199例AIN中感染所致180例(90.4%),以呼吸道感染最常见(66.8%),其次为消化道感染。病原学以病毒为主,包括EB病毒、柯萨奇病毒、呼吸道合胞病毒等。药物所致AIN有125例,均为感染后用药,以非甾体类抗炎药(52.5%)、抗生素(30.3%)最多见,其次包括中草药、感冒药等。非感染性疾病所致AIN有19例(9.5%),包括蜂蛰伤、中毒、外科手术等。临床表现包括发热117例(58.8%)、呕吐60例(39.2%)、腹痛46例(30.2%)、腹泻35例(17.6%)、嗜酸性粒细胞升高9例(4.5%)、皮疹9例(4.5%)等全身症状,以及血尿147例(73.9%)、水肿86例(43.2%)、少尿或无尿82例(41.2%)等肾受累表现。典型三联征在本组中未见。69例(34.7%)有急性肾功能不全,50例(26.1%)24h尿蛋白升高(平均0.49±0.45g/24h),尿常规示血尿(73.9%)、蛋白尿(64.3%)、无菌性白细胞尿(28.6%)。4例行肾活检,以小管间质病变为主,肾小球及肾血管基本正常。所有患儿入院后均采取去除诱因及对症治疗,46例因ARF、中毒行血液净化,其中6例联合使用糖皮质激素,肾功能及尿检均在短期恢复正常。结 论：引起儿童AIN 最主要的原因为感染,以病毒感染为主,其次为药物。临床表现以不明原因肾功能下降及尿检异常为主,重者可发生急性肾功能衰竭。及时诊断、去除诱因为治疗的关键,必要时血液净化及短期糖皮质激素治疗,多数预后良好。

Abstract:

Objective: To analyze the clinical features, pathological changes and treatment of acute interstitial nephritis (AIN), improve the understanding and clinical diagnosis of AIN. Methods: 199 cases of children AIN in our hospital during the period of January, 2010 to December, 2017 were analyzed about the clinical features, auxiliary examination and treatment outcome. Results: There were 180 cases of infection-induced AIN in199 cases, accounting for 90.4%, respiratory infections were the most common (66.8%), followed by digestive infection. The main pathogens are virus infection, including EB virus, Coxsackie virus, Respiratory syncytial virus and so on. 125 cases of DAIN, Non-steroidal anti-inflammatory drugs (52.5%) and antibiotics (30.3%) were the most common. 19 cases (9.5%) of Non-infectious diseases, including bee stings, poisoning, Surgery and so on. The main clinical manifestations included 117 cases of fever (58.8%), 60 cases of vomiting (39.2%), 46 cases of abdominal pain (30.2%), 35 cases of diarrhea (17.6%), 9 cases of eosinophilia (4.5%), and 9 cases (4.5%) of rash. renal damage include 147 cases (73.9%) of hematuria, 86 cases (43.2%) of edema, 82 cases (41.2%) of oliguria or anuria. Typical triads are not seen in this study. 69 patients (34.7%) had ARF, 50 patients (26.1%) had an increase in 24h urinary protein (mean 0.49 ± 0.45g/24 h). Urine routine include hematuria (73.9%), proteinuria (64.3%), leukocyturia (28.6%) . Four cases of renal biopsy were performed with tubulointerstitial lesions, and the glomerulus and renal vessels were basically normal. All patients were treated with removal cause and symptomatic treatment, 46 patients were treated with blood purification because of ARF or poisoning, 6 of them were combined with glucocorticoid, renal function and Urine tests returned to normal in the short term. Conclusion: The main cause of AIN in children is infection, mainly viral infection, followed by drugs. The clinical manifestations is unexplained renal function decline and abnormal urine test. Acute renal failure may occur in severe cases .Timely diagnosis and remove the cause of the key to treatment, blood purification and short-term glucocorticoid therapy if it is necessary, most of them have a good prognosis.