Idiopathic acute interstitial nephritis associated with anterior uveitis in adults.
Idiopathic acute interstitial nephritis associated with anterior uveitis in adults.
复制标题
成人特发性急性间质性肾炎与前葡萄膜炎相关。
作者：
Patrice Cacoub;G. Deray;P. L. Hoang;A. Baumelou;Hélène Beaufils;F. D. Groc;F. Rousselie;C. Jouanneau;Claude Jacobs
一些全身性疾病中已描述了伴随的肾脏和眼部病变。急性间质性肾炎 (AIN) 与不明原因的前葡萄膜炎之间的关联首次在儿童中被描述。最近，在成人中也报道了相同的临床关联。我们报告了 3 个这种关联的案例并进行了文献综述。包括我们的 3 名患者在内，已有 7 例成人报告存在这种关联。所有患者均为27-74岁的女性。最初的症状要么是眼部症状，要么是假病毒症状（发烧、肌痛和疲劳）。肾脏组织学研究显示急性间质性肾炎伴有肾小管病变。免疫荧光和电子显微镜没有贡献。眼部预后始终良好。 5 名患者的肾功能进展良好，急性肾衰竭在几周内完全缓解。未接受全身类固醇治疗的四名患者中，有两名出现慢性肾衰竭（其中一名患者发展为终末期肾衰竭）。其中 3 名患者每天接受 60 毫克泼尼松治疗，没有一人出现慢性肾功能衰竭。尽管报告的患者数量较少且有可能自发消退，但这些数据表明全身类固醇治疗对预防或减少间质炎症和随后的纤维化具有有益作用。
Concomitant renal and ocular lesions have been described in a few systemic diseases. The association of acute interstitial nephritis (AIN) and anterior uveitis without determined cause was first described in children. Recently, the same clinical association has been reported in adults. We report 3 cases of this association and present a review of the literature. Including our 3 patients, 7 cases of this association have been reported in adults. All patients were females aged 27-74 years. Initial symptoms were either ocular, or pseudoviral (fever, myalgia and fatigue). Histological renal studies revealed acute interstitial nephritis with tubular lesions. Immunofluorescence and electron microscopy were not contributive. Ocular prognosis was always good. In 5 patients, the evolution of renal function was excellent with complete resolution of acute renal failure within a few weeks. Chronic renal failure developed in two of the four patients who did not receive systemic steroid therapy (with evolution towards terminal renal failure in one patient). Three of the patients received 60 mg per day of prednisone and none of them developed chronic renal failure. Despite the small number of patients reported and the possibility of spontaneous regression, these data suggest a beneficial effect of systemic steroid therapy to prevent or reduce interstitial inflammation and subsequent fibrosis.