老年药物相关性急性肾衰竭临床表现及病理分析  

Clinical Manifestation and Pathology of Drug-related Acute Renal Failure in Elder Patients

作　　者：赵翠霞[1,2] 王廉一[3] 史晓虎[1] 李文歌[1] 杨冠男[1] 方静[1] 邹古明[1] 

机构地区：[1]中日友好医院肾内科,北京100029 [2]新疆医科大学附属中医医院老年病科,乌鲁木齐830000 [3]清华大学附属第一医院心脏中心超声科,北京100016

出　　处：《中国医院用药评价与分析》2011年第8期741-744,共4页Evaluation and Analysis of Drug-use in Hospitals of China

摘　　要：目的:探讨老年药物相关性急性肾衰竭的临床表现、病理特点及相关药物。方法:回顾分析2005年1月—2010年3月在中日友好医院进行了肾穿刺的21例老年药物相关性急性肾衰竭患者的临床表现、肾脏病理、治疗与预后,以及导致急性肾衰竭的药物。结果:21例患者出现少尿6例,无尿3例,尿量正常12例;镜下血尿7例,无肉眼血尿;出现无菌性白细胞尿3例;24 h尿蛋白定量≤1.0 g者5例,1.0～3.5 g者11例,≥3.5 g者5例;患病前肾功能正常9例、轻度肾衰竭3例、不详9例,入院时血清肌酐为(597.9±426.7)μmol.L-1;入院时B超检查示:肾脏大小正常17例、增大4例。肾穿刺活检肾脏病理示:急性肾小管间质肾炎10例,亚急性肾小管间质肾炎3例,慢性肾小管间质肾病2例,特发性膜性肾病合并急性肾小管间质肾炎2例、不典型膜性肾病合并急性肾小管间质肾炎1例I、gA肾病合并急性肾小管间质肾炎2例,糖尿病肾病合并急性肾小管间质肾炎1例。出院时血清肌酐为(191.7±106.8)μmol.L-1,无1例死亡。可能导致急性肾衰竭的药物包括:抗生素、中成药、非甾体抗炎药、血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体阻断剂、保健品、抗结核药等。结论:老年人是药物相关性急性肾衰竭的高危人群,易导致肾损害的药物较多,老年人在服用常用药物尤其是服用多种药物时,也可导致急性肾衰竭。若能早期发现肾损害,及时诊治,多数患者预后良好,但患病前已存在慢性肾脏病的患者,急性肾衰竭多较重,可转为慢性肾衰竭。OBJECTIVE：To explore the clinical manifestation,pathological feature and the related drugs of drug-related acute renal failure in elder patients.METHODS：A total of 21 elder patients who underwent renal puncture in China-Japan Friendship Hospital from January 2005 to March 2010 were reviewed with regard to clinical manifestations,renal pathology,treatment,prognosis,and the drugs involved in acute renal failure.RESULTS：Of the 21 cases reviewed,oliguria was noted in 6,anuria was noted in 3 and normal urinary volume was noted in 12;7 had microscopic hematuria yet without gross hematuria;3 had aseptic leukocyturia;24-hour urinary protein level of ≤1.0 g·d-1 was noted in 5,of 1.0-3.5 g·d-1 in 11 and of ≥3.5 g·d-1 in 5 cases.Prior to onset of acute renal failure,9 had normal renal function;3 had mild renal failure,and the renal function in 9 remained unknown.Serum creatinine on admission was（597.9±426.7）μmol·L-1.On admission,ultrasonic examination revealed normal kidney size in 17 cases and enlarged kidney in 4 cases.The pathological findings of renal biopsy showed acute tubular interstitial nephritis in 10 cases,subacute tubulointerstitial nephritis in 3,chronic tubulointerstitial nephropathy in 2,idiopathic membranous nephropathy associated with acute renal tubulointerstitial nephritis in 2,atypical membranous nephropathy associated with acute tubular interstitial nephritis in one case,IgA nephropathy associated with acute tubular interstitial nephritis in 2 and diabetic nephropathy associated with acute tubular interstitial nephritis in 1 case.Scr at discharge was（191.7±106.8）μmol·L-1.No patient died.The acute renal failure were induced by antibiotics,traditional Chinese medicine,NSAIDs,angiotensin converting enzyme inhibitors/angiotensin Ⅱ receptor antagonist,health care products,antituberculosis drugs etc.CONCLUSION：Elder patients had high risk for drug-induced renal failure.Many drugs can induce renal failure.Taking common drugs especially when multiple drugs are used concurrently ma

关 键 词：老年 药物 急性肾衰竭 肾脏病理 

分 类 号：R969.3[医药卫生—药理学]