咪唑立宾致高尿酸血症继发肾结石和急性肾衰竭  

Renal calculus and acute renal failure secondary to hyperuricemia induced by mizoribine

作　　者：王卫 贾志缃 周华 Wang Wei;Jia Zhixiang;Zhou Hua(Kidney Transplantation and Blood Purification Center,Second People′s Hospital of Shanxi Province,Taiyuan 030012,China)

机构地区：[1]山西省第二人民医院肾移植透析中心一区,太原030012

出　　处：《药物不良反应杂志》2023年第1期57-59,共3页Adverse Drug Reactions Journal

摘　　要：1例37岁男性肾移植患者术后给予他克莫司、西罗莫司及甲泼尼龙抗排斥治疗,移植肾功能恢复良好,血肌酐130μmol/L左右,血尿酸350μmol/L左右。肾移植术后2年6个月,因患者出现双下肢水肿,将西罗莫司换为咪唑立宾。服用咪唑立宾21 d后患者出现恶心、纳差、尿量减少(1500 ml/24 h),症状逐渐加重。实验室检查示血肌酐635μmol/L,血尿酸1750μmol/L;移植肾彩色多普勒超声(彩超)示移植肾多发结石,彩色血流信号减少。诊断为移植肾急性肾衰竭,高尿酸血症,移植肾结石。考虑与服用咪唑立宾有关,停用该药,换为西罗莫司,并给予血液透析、降尿酸、碱化尿液等治疗。6 d后,患者无恶心、纳差,尿量3000 ml/24 h,血肌酐247μmol/L、血尿酸207μmol/L,移植肾彩超未见结石,彩色血流信号丰富;13 d后,血肌酐156μmol/L,血尿酸123μmol/L。A 37-year-old male patient was treated with tacrolimus,sirolimus,and methylprednisolone after renal transplantation to prevent rejection reaction.The function of the transplanted kidney recovered,serum creatinine was about 130μmol/L,and serum uric acid was about 350μmol/L.After 2 years and 6 months of renal transplantation,sirolimus was switched to mizolibin due to edema of his lower extremities.After taking mizolibin for 21 days,the patient developed nausea,poor appetite,and decreased urine volume(1500 ml/24 h),and the symptoms gradually worsened.Laboratory tests showed serum creatinine 635μmol/L and serum uric acid 1750μmol/L.The color Doppler ultrasonography of the transplanted kidney showed multiple stones and decreased color of blood flow signal.Acute renal failure,hyperuricemia,and calculus in transplanted kidney were diagnosed.Considering that it was related to mizolibin,the drug was discontinued and replaced by sirolimus,and hemodialysis,uric acid lowering,alkalizing urine,and other treatments were given.After 6 days of mizolibin discontinuation,the patient had no nausea or poor appetite.His urine volume was 3000 ml/24 h,serum creatinine was 247μmol/L and serum uric acid was 207μmol/L.The color Doppler ultrasonography of the transplanted kidney showed no stone with abundant colorful blood flow signals.After 13 days of mizolibin discontinuation,the serum creatinine was 156μmol/L and the serum uric acid was 123μmol/L.

关 键 词：高尿酸血症 肾结石 咪唑立宾 急性肾衰竭 

分 类 号：R969.3[医药卫生—药理学]