ストマイ過敏症によると思われる急性腎不全の1例について -とくにその免疫学的考察-

Abstract

A case of acute renal failure following streptomycin shock was reported. The patient, 59-year-old man, received an operation for fistula ani without any trouble. On the 2nd postoperative day, the patient was administered streptomycin sulfate (SM) 0.5 g and sulfisomidium (SF) 0.2 g intramuscularly. About 20 minutes after the injections, dyspnea, hypotension (below 60 mmHg systolic) and unconsciousness abruptly occurred. Immediately vasopressor drug (nor-epinephrine) and corticosteroid (hydrocortisone) were given and intravenous fluid infusion was started. One hour later, unconsciousness and hypotension improved, but anuria (below 100 ml/day) was persistent for 3 days. Azotemia, hypertension and acidosis were recognized. On the 2nd day of shock episode, laboratory data was as follows, BUN 58 mgjdl, serum Na 134mEq/L, K 5.8mEq/L, CI 91mEq/L. Hemodialysis was started on the 3 rd day and daily urine volume began to increase on the 13th day. Sixteen times of hemodialysis was required until the 23 rd day. It took 70 days that BUN and serum creatinine returned to normal value. Hypersensitivity tests to SM and SF were done and data were as follows. 1) Blastoid transformation rate of peripheral blood lymphocytes was higher with SM than with SF. 2) Macrophage migration inhibition test was positive by SM, but negative by SF. 3) Patch test of skin revealed pseudopositive by SM. Needle biopsy of the kidney proved usual changes in acute tubular necrosis. There was no specific change of the glomeruli. Above data suggested that the patient was hypersensitive to SM and acute renal failure was due to SM shock.