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Tubulointerstitial Nephritis-An Under-Recognized Renal Disease
腎小管間質腎炎－一個被低估的腎臟疾病
摘要
背景：腎小管間質腎炎是造成腎衰竭一個重要的原因，然而因為它的臨床症狀不明顯，很容易被忽略掉，而造成臨床診斷率下降。 病人選擇及方法：從2000年到2004年，單一醫學中心回溯性的自346位接受腎臟切片者進行分析。將病理學家診斷為原發性腎小管間質腎炎的切片選出，我們分析它的盛行率，發生原因，及其預後。 結果：原發性腎小管間質腎炎共發現在71位病人切片上（佔20.5%）；其中有7個病人因為臨床資料不完整而被排除掉。剩下64位病人進行分析。16個病人於病理切片上診斷為急性腎小管間質腎炎（第一群組），26個病人則是其他腎絲球疾病合併伴有腎小管間質腎炎（第二群組），22個病人切片報告為慢性腎小管間質腎炎（第三群組）。綜合分析，造成急性腎小管間質性腎炎的原因（第一加第二群組）為：感染4個，11個為藥物，替代性藥物療法所造成的有14個。造成慢性腎小管間質性腎炎這一群組的22個病人中，有15個人和草藥有關。不確定原因者在42個急性腎小管間質腎炎群組中佔有13個，而在慢性腎小管間質性腎炎22個中有7個。切片前的正確診斷率在第一群組為50%，在第二群組為27%；而在第三群組為災％。急性腎小管間質腎炎群組中，腎臟破壞的情形為不可逆者有40.5%；而慢性腎小管間質腎炎群組則為13.6%。 結論：腎小管間質腎炎實際上的發生率比臆測高出許多。經由分析，藥物及草藥是最主要的原因。詳細的臨床病史詢問及過去的藥物史探討，可以高度的提醒我們此疾病的診斷及發生。
並列摘要
Background: Tubulointerstitial nephritis (TIN) is an important cause of renal failure. However, the clinical presentation is usually not specific and under-diagnosed. Patients/Methods: A single-center retrospective analysis of renal biopsy results from 346 consecutive patients between 2000 through 2004. Primary target pathogenic process in tubulointerstitial compartment cases was collected. We investigate the TIN prevalence, causative agents and clinical outcome. Results: Primary TIN was identified in 71 (20.5%) biopsies; seven cases were excluded because of incomplete clinical profile. Therefore 64 cases remained for this study. Sixteen patients were ATIN only (Group 1), 26 patients were ATIN superimposed on pre-existing glomerular disease (Group 2) and 22 cases were CTIN (Group 3). Causative agents in ATIN (Group 1 and 2) were: infection in 4, drugs in 11, alternative medicine in 14. Herbal medicines caused 15 of 22 CTIN cases (68.2%). Causes were uncertain in 13 of 42 ATIN and 7 of 22 CTIN cases. Pre-biopsy suspicions were accurate in 27% ATIN with pre-existing glomerulopathy and in 50% ATIN without; it was 91% in CTIN. Renal damage was reversible in 40.5% ATIN and 13.6% CTIN cases. Conclusions: Half of the renal biopsy patients whose clinical diagnosis was not TIN showed it in pathologic findings. TIN incidence is higher than suspected and under-diagnosed in clinical nephrology practice. Drugs and alternative medicines are major causes. Investigating clinical history and emphasize on drug history, and high clinical awareness will improve diagnosis and prevent this devastating renal disorder.