内科常用药物相关的急性肾衰竭

药源性急性肾衰竭（DARF）是指药物引起的以急性水、电解质紊乱和酸碱平衡失调及氮质血症为主要特征的一组临床综合征。DARF是一种常见的药源性疾病，约占肾实质性急性肾衰竭的19％～40％。其临床特点是在用药数日或数周内出现少尿或非少尿型ARF，部分患者可同时出现药疹、药物热、贫血、肝功能损害、神经系统损害等表现。DARF最常见的临床病理类型有急性肾小管坏死、急性间质性肾炎。DARF的发病机制主要为药物引起肾血流动力学改变导致肾灌注量减少、对肾小管细胞的毒性作用导致急性肾小管坏死、免疫反应导致急性间质性肾炎、药物结晶沉积导致管腔阻塞或免疫介导的肾小球肾炎等。DARF的相关危险因素包括药物的肾毒性作用、剂量、疗程，以及患者的机体状态如：高龄、血容量不足、糖尿病、既往肾损害或肾功能不全等。DARF的常见致病药物有抗生素、非甾体抗炎药、利尿剂及某些中药等。本文重点介绍内科常用的心血管系统药物、消化系统药物及抗病毒药导致DARF的临床特点及其防治。

Acute renal failure associated with drugs commonly used in department of internal medicine

Drug-induced acute renal failure （DARF） refers to a clinical syndrome characterized by acute disturbances of water and electrolytes, acid-base imbalances, and azotemia. DARF is a common drug-induced disorder, accounting for about 19 to 40 percent of parenchemal acute renal failure. Its clinical features were the occurrence of oliguria- or nonoliguria-type ARF several days or weeks after the exposure to causative drugs. A part of patients may present with drug rash, fever, anemia, liver injury, nervous system impairment, and so on. The most common clinical-pathological types of DARF include acute tubular necrosis and acute interstitial nephritis. The main mechanisms of DARF involve in renal hypoperfusion secondary to hemodynamics alteration induced by drugs, acute tubular necrosis caused by toxicity to tubular epithelial cells, acute interstitial nephritis caused by hypersensitivity, lumens obstruction resulting from drug crystal deposition and glomerulonephritis mediated by immune reaction. The relevant risk factors for DARF include nephrotoxicity of drugs, dosage, treatment duration, and the patients ＇status, such as advanced age, blood volume insufficiency, diabetes, previous kidney damage or renal insufficiency, etc. Common drugs associated with DARF include antibiotics, non-steroid anti-inflammatory drug, diuretics and certain medical Chinese herbs. The key point of this article is to introduce the clinical features, prevention and treatment of DARF caused by drugs frequently used in cardiovascular systems, gastrointestinal systems, and anti-virus drugs.