抗感染药物导致的急性肾损伤

近年来抗感染药物所致急性肾损伤（AKI）有增多趋势。国内资料显示,在药物所致AKI中抗菌药占39.0%～54.0%。引起AKI的抗感染药主要有氨基糖苷类、β-内酰胺类、多肽类和喹诺酮类等。AKI一般发生于患者用药后数日或数周,临床表现为少尿或非少尿型急性肾功能不全,其病理表现为急性肾小管坏死和急性间质性肾炎。发病机制与患者机体免疫反应和药物的直接肾毒性有关。高龄、肾功能不全以及合用其他药物等是AKI的高危因素。一旦发生AKI应立即停药,并给予泼尼松或肾透析治疗。临床医生应重视高危人群的合理用药,避免大剂量或长期用药,加强对患者肾功能监测,以降低AKI的发生率,改善预后。

Acute kidney injury caused by anti-infective drugs

In recent years acute kidney injury（AKI）caused by anti-infective drugs is on an upward trend.Domestic data show that 39.0%-54.0% of the cases of drug-caused AKI are related to anti-infective drugs,mainly aminoglycosides,β-lactams,glycopeptides,quinolones,etc.AKI usually occurs a few days or weeks after drug administration.The clinical manifestations include mainly oliguria or non-oliguric renal insufficiency.The pathologic appearance includes acute necrosis of renal tubules and acute interstitial nephritis.The risk factors for anti-infective drug-caused AKI include advanced age,renal insufficiency and combined use of anti-infective drugs with other medicines.If anti-infective drug-caused AKI occur,the drug should be withdrawn immediately and prednisone or renal dialysis given.The clinicians should pay attention to the rational drug use among the high-risk population,avoid high dosage and long-term use of the drug,and monitor the kidney function of patients so as to decrease the incidence of AKI and improve the prognosis.