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机构地区:[1]浙江大学医学院附属第二医院肾内科,杭州310009
出 处:《中国现代应用药学》2006年第5期428-430,共3页Chinese Journal of Modern Applied Pharmacy
摘 要:目的探讨阿昔洛韦致急性肾功能衰竭(ARF)的临床特征。方法报道3例阿昔洛韦诱导的ARF的临床表现,实验室检查及肾组织活检结果,并对相关文献进行复习。结果①3例均为中年患者,平均年龄51.6岁,2例患者在用药24h内起病;②临床表现不典型,仅1例以少尿为主要表现,2例伴有明显的腰痛,3例均无蛋白尿和镜下血尿;平均血肌酐水平385μmol/L;③3例均行肾图检查,均提示C段排泄延缓,1例肾组织活检提示部分肾小管扩张,肾小管内可见晶体样物质,伴肾间质明显水肿。④全部患者均予以利尿、护肾等常规对症处理,肾功能于3~11d内完全缓解。结论阿昔洛韦导致的ARF以肾小管内梗阻为主要病理机制,腰痛是其突出的临床特征,患者多呈良性经过,预后佳,规范用药是预防的重要措施。OBJECTIVE To investigate the clinical characteristics of acyclovir-induced acute renal failure(ARF). METHODS Three cases with acyclovir induced ARF were reported retrospectively and the related literatures were reviewed. RESULTS ①Three patients were middle-aged with a mean age of 51.6, and ARF developed within 24 hours of acyclovir administration. ②ARF was untypical, only 1 patient experienced oliguria, 2 patients accompanied significant flank or abdominal pains and all patients represented no proteinuria and microhematuria. ③We performed renal ECT on all cases and found C stage showed significant excretion retarded. The renal biopsy of one patient showed expanded tubular, swelling interstitial and some crystalline lens in tubular, without the involvement of glomerli. ④All cases recovered completely with discontinuation of acyclovir therapy and volume resuscitation in 3-11 days. CONCLUSION Intratubular crystal deposition and tubular obstruction was the main mechanism of acyclovir-induced ARF. Flank or abdominal pains is its significant symptom. All case recovered soon and normative usage of acyclovir is the key to prevent ARF occurred.
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