一个不常见的罪祸首:PPI诱导的青少年急性管间膜炎
Rehna K Rahman1, Huda Alghfeli2, Mayada Raya2
1Department of Pediatrics, Burjeel Medical City, Mohamed Bin Zayed City, Abu Dhabi, UAE. drrehnashabeer@gmail.com.
Pediatric nephrology (Berlin, Germany)
|February 16, 2026
概括
质子抑制剂 (PPI) 诱导的急性管间炎 (ATIN) 是儿童罕见但严重的疾病. 及时诊断和用皮质类固醇治疗以及停止PPI治疗对于儿科患者的康复至关重要.
科学领域:
- 儿科脏病学 儿科脏病学
- 临床药理学 临床药理学
- 内部医学 内部医学
背景情况:
- 质子抑制剂 (PPI) 在儿童中被广泛使用.
- 由PPI诱导的急性管间性炎 (ATIN) 是小儿病群中急性损伤 (AKI) 的未被认可的原因.
- 临床表现可能是不特定的,导致诊断延迟.
研究的目的:
- 在儿科患者中报告与PPI相关的ATIN病例.
- 强调考虑PPI作为儿童无法解释的AKI潜在原因的重要性.
- 突出诊断发现和成功的管理策略.
主要方法:
- 一个16岁的男性患有持续的胃肠道症状和体重减轻的病例报告.
- 临床评估包括实验室检测 (肌素,尿液分析,尿液β2-微球蛋白) 和脏超声波.
- 脏活检用于组织病理学检查.
- 用皮质类固醇治疗和停止PPI治疗,同时根除Helicobacter pylori.
主要成果:
- 患者呈现出肌水平升高,代谢性化症,无菌性皮尤里亚,葡萄糖尿和尿液β2-微型球蛋白增加.
- 脏活检证实了T淋巴细胞占主导地位的带有埃索诺菲尔的管状间歇性炎症,表明过敏度介导的ATIN.
- 在皮质类固醇治疗和停止PPI后,功能显著改善.
- 患者完全康复,没有长期的后果.
结论:
- 在儿童AKI的差异诊断中,应考虑PPI诱导的ATIN,特别是有PPI暴露史的人.
- 早期识别,活检和及时管理 (皮质类固醇,PPI撤销) 是有利结果的关键.
- 这一案例强调了需要提高儿童对药物诱导的损伤的认识.
相关概念视频
01:27Acute Pyelonephritis I: Introduction
762
Pyelonephritis is a bacterial infection that primarily affects the renal parenchyma and collecting system, including the renal pelvis, tubules, and interstitial tissue of one or both kidneys. It can be classified as either acute—a sudden, severe infection—or chronic, which refers to long-term or recurrent kidney infections.The primary cause of acute pyelonephritis (APN) is bacterial infection, with Escherichia coli accounting for approximately 70-80% of cases. Other bacteria, such...
762
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
468
Introduction:For diagnosing acute pyelonephritis, a comprehensive patient history is collected to identify symptoms such as dysuria, frequent or urgent urination, flank pain, or costovertebral angle (CVA) tenderness that may suggest a kidney infection.Physical ExaminationDuring the physical examination, CVA tenderness is assessed. This involves gentle percussion over the costovertebral angle, where tenderness often indicates a kidney infection.Diagnostic TestsUrinalysis: Used to identify white...
468
01:29Acute Kidney Injury II: Pathophysiology
1.2K
Acute kidney injury (AKI) causes are categorized into three primary categories based on the location of the injury: prerenal, intrarenal (or intrinsic), and postrenal causes. This classification guides clinical management and illustrates how different pathways can impair kidney function.Etiology and Pathophysiology of Acute Kidney Injury1. Prerenal causesEtiology: Prerenal Acute Kidney Injury, the most common type, occurs when reduced blood flow to the kidneys decreases filtration capacity...
1.2K
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
354
Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
354
01:26Kidney Transplant II: Surgical Procedure
462
Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living...
462
01:22Acute Kidney Injury I: Introduction
828
Introduction:Acute Kidney Injury (AKI) describes a swift decrease in kidney function occurring over hours to days, characterized by the kidneys' failure to remove waste products from the bloodstream. This leads to dangerous complications like metabolic acidosis, fluid overload, and electrolyte imbalances, such as hyperkalemia, which can cause life-threatening arrhythmias. AKI is common in both hospital and outpatient settings, often triggered by dehydration, sepsis, or exposure to nephrotoxic...
828