阿昔洛韦静脉滴注致急性肾功能衰竭10例分析

阿昔洛韦为人工合成的第2代核苷类广谱抗病毒药物,对单纯性疱疹病毒、水痘带状疱疹病毒、巨细胞病毒等都具有高度选择性抑制作用,是临床治疗生殖器疱疹病毒感染、带状疱疹、免疫缺陷者水痘等疾病的一线药物[1、2]。因疗效好、不良反应少而广泛使用,近年来随着临床的推广,有关阿昔洛韦不良反应的报道也逐渐增多,尤其是导致急性肾功能衰竭(ARF)     

阿昔洛韦静脉滴注致急性肾功能损害

患者男,35岁。因左颈部、肩部水疱,疼痛1周,腰痛3d,于2003年2月10日来院就诊。患者1周前劳累后左颈部、肩部突发米粒至绿豆大小丘疹、丘疱疹、水疱,皮疹渐增多,伴阵发性刺痛。发病第4天在当地医院诊断为“带状疱疹”,给予阿昔洛韦0.5g 5%葡萄糖注射液500mL静滴,1次/d。次日,当输入液体约150mL时,患者突感腰部疼痛,活动受限,立即终止输液,经卧床休息后,疼痛稍缓解。2d后,症状仍无明显改善,遂来我科就诊,门诊以“带状疱疹,腰痛待查”收入院。发病以来,无发热、畏寒,心悸、气促,腹痛、腹泻、头痛、呕吐、少尿、血尿等症状。精神尚可,食欲、睡…     

阿昔洛韦致急性肾功能衰竭1例

1　病例介绍患者 ,女 ,44岁 ,因“腰痛 ,少尿伴恶心、呕吐 3ｄ”于 2 0 0 0年7月 2 5日入院。患者 3ｄ前因右侧眼周带状疱疹在当地卫生院行抗病毒治疗 (阿昔洛韦 3 0 0ｍｇ ,静脉滴注 ,ｑｄ)。第 2天在输液过程中突感双侧腰部剧烈疼痛 ,伴恶心、呕吐 ,并出现少尿 ,全天尿量约 15 0ｍＬ ,色深黄 ,无发热、尿频、尿急、尿痛、关节痛、皮疹等 ,予抗炎、解痉等治疗无好转。尿常规 :蛋白 + + ,白细胞+ +。血尿素氮 (ＢＵＮ ) 14 .9ｍｍｏｌ·Ｌ 1 ,肌酐 (Ｃｒ) 5 0 8.5μｍｏｌ·Ｌ 1 。双肾彩超示“双肾各级动脉舒张期血流减小至消失。”诊断…     

阿昔洛韦致急性肾功能衰竭3例

带状疱疹是由水痘-带状疱疹病毒引起的皮肤科常见病,阿昔洛韦是最常用的抗病毒药物,有较好的临床疗效。但其主要是经肾小球过滤和肾小管分泌后从尿中排出,到达肾小管腔的浓度较高,60%～90%以原形从肾脏排泄。本品在尿中相对不溶,特别是在尿流下降的远曲小管腔,可致肾     

阿昔洛韦致急性肾功能衰竭一例

1 病例资料 男,35岁.主因生殖器红肿、痒痛就诊.泌尿外科诊断为生殖器疱疹.给予阿昔洛韦(湖北潜江制药有限公司生产,批号20060801)0.25 g加入250 ml生理盐水静脉滴注,连续用药3天未见好转,用药期间无不适,第4天继续滴注阿昔洛韦,剂量同前,滴入约60 ml时患者诉腰酸痛,但可忍受,未予处理,继续将利余药液滴完,治疗历时40分钟.     

阿昔洛韦致急性肾功能衰竭1例

患者，女，59岁，平素体健，无高血压、糖尿病、肾病和药物过敏史，乙肝病毒携带者。2005年7月12日在皮肤病专科医院诊断为：右侧头颈带状疱疹。给予0．9％氯化钠注射液250ml＋阿昔洛韦0．5g（丽珠科益，批号：050509）ivd，qd；同时口服阿昔洛韦胶囊0．2g，tid；泼尼松10mg，po，bid；凉血解毒口服液10ml，bid；重组基因干扰素100万iu。im，qod，（长春长征基因药业，批号：041005—4）。     

大剂量阿昔洛韦致急性肾功能衰竭

患者男,46岁。因腰痛、呕吐2d入院。2d前因生殖器疱疹在当地诊所予以阿昔洛韦0.75g加入5%葡萄糖注射液250ml中静脉滴注,当天晚间即出现腰部疼痛、酸胀,第2天出现恶心、呕吐,尿量无明显减少。入院时查体:T37.0℃,P98次/min,R20/min,BP120/70mmHg(1mmHg=0.133kPa)。阴茎部位散在疱疹。双肾区有压痛、叩击痛,双侧有肋脊点压痛,双下肢无水肿。尿常规:尿蛋白(++),潜血(+),RBC1～2个/HP,WBC2～3个/HP,尿比重1.010,尿pH值5.5。血尿素氮(BUN)10.6mmol/L,肌酐(Cr)303μmol/L,入院第2天BUN14.3mmol/L,Cr610μmol/L;第3天BUN16.4mmol/L,…     

阿昔洛韦致急性肾功能衰竭一例

1 病例资料 男,35岁.主因生殖器红肿、痒痛就诊.泌尿外科诊断为生殖器疱疹.给予阿昔洛韦(湖北潜江制药有限公司生产,批号20060801)0.25 g加入250 ml生理盐水静脉滴注,连续用药3天未见好转,用药期间无不适,第4天继续滴注阿昔洛韦,剂量同前,滴入约60 ml时患者诉腰酸痛,但可忍受,未予处理,继续将利余药液滴完,治疗历时40分钟.     

阿昔洛韦致急性肾功能衰竭文献分析

目的探讨阿昔洛韦致急性肾功能衰竭（ARF）的主要原因及防治措施。方法查阅《中国医院知识仓库（CHKD）全文期刊库）2006～2009年阿昔洛韦致泌尿系统损害的有关文献（19例）,进行统计、分析。结果阿昔洛韦致急性。肾功能衰竭发生的频度虽然不高,但其危害极大,且主要由于不合理用药所致,如超适应证用药、用药量过大、滴注浓度过高、滴速过快、不合理配伍等。结论临床医师、药师应重视阿昔洛韦所致的泌尿系统严重不良反应,严格把握用药指针,确保临床合理用药。     

阿昔洛韦致急性肾功能衰竭二例报告

阿昔洛韦致急性肾功能衰竭在国外陆续有报道 ,我院近期连续收治 2例 ,现报道如下。例 1:患者 ,女 ,2 4岁 ,因“呕吐、少尿、腰痛 1天”入院。入院前 3天腹部、双下肢出现少许红色皮疹 ,在当地医院诊断为“疱疹” ,遂一次性输入阿昔洛韦1ｇ(4支 ) ,4小时后出现剧烈呕吐 ,腰部胀痛 ,继而少尿 ,2 4小时尿量约 10 0ｍｌ左右 ,无发热。既往身体健康。入院时查 :体温 36 5℃ ,血压 16 0 / 80ｍｍＨｇ ,急性病容 ,无酒醉貌 ,腹部及双下肢可见少许散在的红色充血性皮疹 ,呼吸平稳 ,心肺未见异常 ,腹软 ,剑下压痛 ,肝脾未扪及 ,双肾区叩痛 ,双下肢轻…     

阿昔洛韦静脉滴注导致急性肾衰

患者男,31岁。因腰部疱疹、左侧腰部剧痛,发生族状分布水泡,沿神经根行走,2006年2月24日在本院就诊给予阿昔洛韦750mg静脉滴注,1次/d,疱疹疼痛症状有所缓解。当第3天滴注时,即出现腰骶部剧烈疼痛,立即停止输液,口服双氯芬酸片75mg,自觉当日尿量比往日减少(大约1000ml)。查血肌酐206μmol/L,腰背部持续疼痛,尿少(≤400ml/24h)1d,腰部疱疹疼痛已减轻,心、肺、腹无异常,双肾区有叩痛,双下肢无浮肿。于2006年2月27日以急性肾功能衰竭收入院。检查:T36.3℃,P86次/min,R18次/min,BP120/80mmHg(1mmHg=0.133kPa)。给予0.9%氯化钠注射液250ml+盐…     

阿昔洛韦过量致急性肾衰竭

例19岁男性传染性单核细胞增多症患者拟给予阿昔洛韦600 mg加入10%葡萄糖注射液250 ml中静脉滴注.但因用药错误将阿昔洛韦3.0 g加入10%葡萄糖注射液250 ml中静脉滴注.输注完毕后9 h,患者出现明显腰痛,尿量减少,尿蛋白(+ +),尿潜血(+ +).随后出现24 h无尿.第3天肾功能检查:血清肌酐557 μmol/L,尿素9.2 mmol/L.肾脏超声示双肾弥漫性病变.行血液净化,并给予甲泼尼龙40 mg/d静脉滴注,治疗2 d.肾功能逐渐好转,尿量增多.第15天患者肾功能及尿常规检查均无异常,痊愈出院.     

Acute renal failure associated with intravenous immunoglobulins

Intravenous immunoglobulins (i.v.IG) are increasingly used in various clinical situations for which they have been considered to be safe and effective. However, since 1987, some cases of renal toxicity have been reported. Forty-nine cases of acute renal failure have been notified to the French Regional Pharmacovigilance Centers between 1992 and mid 1998. In this series, marked serum creatinine increases (mean 387%+/-181%) appeared within 8 h to 8 days after initiation of i.v.IG therapy. Oliguria was observed in 80% of the cases. Haemodialysis was required for 34% of the patients. The renal failure persisted for a mean duration of 10 days after discontinuation of the i.v.IG treatment. Although risk factors have not been definitely established, preexisting renal impairment and old age seem to predispose to i.v.IG-associated acute renal failure as well as diabetes mellitus or the use of diuretics. The mechanism of renal injury remains speculative but a hyperoncotic overloading may be contributory. Finally, close monitoring of renal function is required in patients with preexisting renal failure, with older age and with diabetes mellitus.     

阿昔洛韦注射液致急性肾功能不全3例

例1女,19岁。因带状疱疹来我院就诊。给予阿昔洛韦750mg,地塞米松10mg静滴治疗。当晚,患者自觉腰酸、恶心、呕吐。次日来院经给予甲氧氯普胺等药对症治疗后,恶心、呕吐稍有好转,但仍觉腰胀,随之出现尿量减少,再次来院就诊。实验室检查,尿常规:PRO(++)、RBC2～9个/HP,WBC0～2/HP,血常规:WBC10.3×109·L-1,N0.83,PLT208×109·L-1,未见异常淋巴细胞;肝功能正常;肾功能:BUN13.96mmol·L-1,Cr348.1μmol·L-1,β2-MG>2.5mg·L-1。诊断:药物性肾损害、急性肾功能不全,收入院。患者以往无特殊病史。入院后给予多巴胺静滴改善肾血流,…     

Acute renal failure

Acute renal failure remains an important clinical problem with little progress made in the therapeutic approach over the past 20-30 years. The purpose of this review is to discuss possible etiologies, their diagnosis, differentiation and possible prevention. The pathophysiology of prerenal azotemia and ischemic acute renal failure are also discussed. The importance of understanding different body volume components, the urine analysis and the FE Na(+) are explained.     

Acute renal failure

Acute renal failure (ARF) is common among critically ill patients and renal dysfunction is often associated with the multisystem organ failure syndrome. The mortality of ARF remains high but animal data indicate that prevention and early treatment may decrease the morbidity and mortality. This review defines ARF based on urine volume, laboratory parameters, and clinical presentation. The pathophysiology of prerenal, postrenal, and intrinsic ART are differentiated and diagnostic criteria provided. Preventive therapy, supportive care, and proposed treatments are outlined. Studies examining the prevention and treatment of ARF in animal models and trials in humans are evaluated. Mannitol 0.5-1 g/kg, furosemide 0.5-1 mg/kg initially, and dopamine 1-5 micrograms/kg/min are effective in preventing or decreasing the severity of ARF in animal models. In humans these drugs are effective at maintaining urine output in various clinical situations and converting oliguria to nonoliguria in some patients; however, increased survival has not been adequately proven as of yet. Dialysis and experimental therapy are briefly discussed.     

Acute liver failure following intravenous methamphetamine

A 41-y-o Pakistani man presented with psychosis, hyperthermia, rhabdomyolysis, and liver dysfunction approximately 6 h after i.v. injection of methamphetamine. Serum concentrations of methamphetamine and amphetamine on admission were 0.30 microg/mL and 0.04 microg/mL, respectively. Total serum bilirubin and alanine aminotransferase concentrations peaked on the 3rd hospital day at 8.6 mg/dL and 4155 IU/L, respectively, and gradually returned to normal with supportive care. The patient had no evidence of infectious hepatitis or intake of other drugs. Histologic examination of a liver biopsy specimen obtained on the 11th d showed confluent necrosis and ballooning degeneration in centrilobular zones. No inflammatory changes were seen in portal tracts. Liver damage can be a complication of illicit methamphetamine use, even in patients without viral infection or intake of other drugs.