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Mycobactrium Tuberculosis Induced Granulomatous Tubulointerstitial Nephritis in the Renal Allograft: A Case Report
結核菌引起移植腎之肉芽腫性腎小管間質腎炎：一病例報告
摘要
肉芽腫性腎小管間質腎炎(Granulomatous tubulointerstitial nephritis)是一種少見的腎小管間質腎炎，常見的原因，包括：感染、藥物、類肉瘤病(sarcoidosis)和威格納氏肉芽腫瘤(Wegenor's granulomatosis)等。移植腎患者因免疫抑制劑的使用，發生結核病的機會較常人為高；而結核病在移值腎所引起的肉芽腫性腎小管間質腎炎，文獻上屬於一罕見疾病。 一位三十歲末期腎病女性於2002年接受腎臟移植後，2004年懷有雙胞胎。懷孕22週時，才初次發現血壓高達：152/115 mmHg，合併有中度蛋白尿（每日尿蛋白排出量：1.89公克）。在懷孕27周時，順利早產出一對雙胞胎；而後的血壓回復正常，但中度蛋白尿仍持續存在且合併有膿尿(pyuria)。回顧以前病史發現早在懷孕前一年時，病人已有持續的下泌尿道感染症狀和膿尿；但多次尿液細菌培養皆無致病菌(sterile pyuria)，對抗生素的反應也不好。生產後兩個月，尿液中培養出結核菌，因此，開始給予抗結核菌藥物治療。因為中度蛋白尿持續存在，安排腎臟切片，其病理發現為肉芽腫性腎小管間質腎炎，但耐酸染色(acid-fast stain)為陰性。在給予抗結核菌藥物治療六個月後，病人的腎功能正常，但仍有輕度至中度蛋白尿。
並列摘要
Granulomatous tubulointerstitial nephritis (TIN) is rarely seen in the renal allograft. Among the renal allografts with granulomatous TIN, only 15 cases were reported to be associated with tuberculosis (TB). Hereby we report an end-stage renal disease female patient and suffered from persistent dysuria and frequency for a flew months later received kidney transplantation. Also, repeated sterile pyuria was found. One year later, she had a twin pregnancy, and hypertension (blood pressure: 152/115 mmHg) and moderate proteinuria developed at 22nd gestational week. Then, she had a preterm delivery at 27th gestational week. Although blood pressure became normal, her proteinuria persisted. Her urine culture yielded Mycobacterium tuberculosis two months later. But no pulmonary TB was found. The renal biopsy demonstrated the picture of granulomatous TIN. After anti-TB combined therapy for six months, her proteinuria, still persisted and her renal function remained stable.