服樂洩麥(Furosemide) 是一種被廣泛使用的利尿劑，常用來治療水腫或是高血壓。本文 報導一位因服用服樂洩麥而導致腎小管間質腎炎的案例。病人為45歲女性，長期大量服用 服樂洩麥來控制體重，門診追蹤時發現腎功能不全，腎臟切片顯示急性及慢性腎小管間質腎 炎。在停止使用服樂洩麥後，病人的腎功能順利恢復至正常範圍。根據一般經驗，服樂洩麥 的耐受性良好，但此藥仍可能造成一些嚴重的副作用，例如：脫水、高尿酸血症、電解質失 衡、耳毒性、藥物過敏及腎小管間質腎炎。大部分的急性腎小管間質腎炎由藥物過敏或感染 症所造成，常見引起的藥物為抗生素及非類固醇消炎藥。治療方式為盡早停止引發過敏的藥 物，必要時可輔以類固醇治療。此類病人最後多半能恢復部分、甚至全部的腎功能，但倘若 病程延長，可能進展至慢性腎小管間質腎炎，腎功能也可能永久性地喪失。在文獻紀錄上， 因服樂洩麥引起腎小管間質腎炎的案例報告並不常見，吾人藉此案例報告強調，在服樂洩麥 被廣為使用的今日，要謹慎注意該藥可能對腎功能造成的不良影響。

Furosemide is a diuretic agent widely used to treat edema or hypertension. We present a 45-year-old woman with interstitial nephritis resulting from chronic furosemide dependence. Impaired renal function was initially found at a clinic. A renal biopsy showed mixed acute and chronic interstitial nephritis. After cessation of furosemide, the patient’s renal function completely recovered. Although furosemide is generally considered safe, serious adverse effects may occur, such as dehydration, hyperuricemia, electrolyte imbalance, ototoxicity, allergic reactions and interstitial nephritis. Most cases of acute interstitial nephritis are caused by drug allergy or infections. Antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs) are the most common offending drugs. Treatment is aimed at early cessation of the offending agents and steroid administration if necessary. After treatment, most patients have partial or complete recovery of renal function. A prolonged course of acute tubulointerstitial nephritis can progress to chronic tubulointerstitial nephritis, in which renal function impairment may be permanent. Since there are few reports of furosemide-related tubulointerstitial nephritis in the literature, we presented this case to remind all physicians of the possible renal toxicity of furosemide. (J Intern Med Taiwan 2015; 26: 217-226)