利福平致急性间质性肾炎伴高尿酸血症1例分析并文献复习  

Rifampicin Related Acute Interstitial Nephritis with Hyperuricaemia:A Case Report and Literatures Review

作　　者：张琳[1,2] 魏日胞[2] 王远大[2] 

机构地区：[1]天津中医药大学第一附属医院,天津300193 [2]解放军总医院肾病科,肾脏病国家重点学科暨重点实验室,北京100853

出　　处：《中国中西医结合肾病杂志》2013年第1期36-38,I0004,共4页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：国家科技重大专项项目(No.2010ZX9102-204);国家自然科学基金资助项目(No.81072914);军队中医药专项基金资助项目(No.10ZYZ255)

摘　　要：目的:报道1例利福平致急性肾衰竭并高尿酸血症,病理诊断为急性肾小管间质损害的病例,提高对利福平肾损害的认识。方法:记录患者出院前用药、临床表现及病理资料,复习相关文献,分析利福平在本病例的作用。结果:患者,男,31岁。入院前1月因排尿不适,当地医院给予利福平(6粒/d,用药剂量900mg/d)联合呋喃妥因治疗溶血性葡萄球菌感染(前列腺液细菌培养结果)20余日。用药后22d发现血肌酐升高达311.8μmol/L,血尿酸升高,以急性肾衰竭收入我院。在完善相关检查后行肾穿刺活检术,病理诊断为急性肾小管间质损害;给予中剂量激素治疗,2周后患者血肌酐恢复正常。结论:本例患者在不当使用利福平后导致急性间质性肾炎伴高尿酸血症,激素治疗有效。提醒临床医师勿滥用抗生素,尤其是利福平这类药;一旦出现药物相关的急性肾衰竭,应尽早到肾脏病专科诊治,争取肾脏病理确诊,合理有效治疗。Objecllve：Report and analysis an acute renal failure caused by rifampicin, who was diagnosis as renal tubular interstitial damage by renal biopsy. Aim to improve the rifampicin renal damage understanding. Methods：The clinical and pathologi- cal data analysis and the related literatures have been reviewed, Meanwhile, find the reason of hyperuricaemia in this patient for the further study. Results： The patient is male, 31 years old, take medicines in local hospital of rifampicin （6tablets/day, dosage 900 mg/day） combined with nitrofurantoin for hemolytic staph infections （The result of prostate liquid bacteria cultivation）for more than 20 days; Seven days before he was hospitalized, the increase of serum creatinine（Scr） has been found, and the use of rifampicin was stop in 5 days before he was hospitalized. He accept renal biopsy in our hospital, diagnosis as renal tubular interstitial damage. After glucocorticoids two week, the Scr was normal. Conclusion：This patient was diagnosed as acute interstitial nephritis and hyperu- ricemia caused by rifampicin abuse, and was improved after glucocorticoids therapy. Clinicians must pay attention to the fundamental of antibiotics therapy, especially for drugs like rifampicin. For those patients, once occurred with the drug - related renal failure, to strive for diagnosis and drug therapy as soon as possible, nephrology department visits and renal biopsy are both important for them.

关 键 词：利福平 急性间质性肾炎 高尿酸血症 

分 类 号：R692.3[医药卫生—泌尿科学]