25例药物性肾损害的临床及病理分析

目的:观察药物诱发肾功能损害的临床表现及病理改变。方法:对1996年-2002年临床诊断为药物性肾损害并发肾功能不全,且经肾脏病理诊断的25例患者进行回顾性分析。结果:25例药物性肾损害病例中,发生急性肾功能衰竭20例,其中病理诊断为急性肾小管坏死13例,急性间质性肾炎7例,死亡2例(占10%),15例临床治愈,3例转为慢性肾损害;发生慢性肾功能衰竭5例,病理均诊断为慢性间质性肾炎,死亡3例。庆大霉素、造影剂、抗癌药物(顺铂)、免疫抑制剂(甲氨蝶呤)、非甾体类抗炎药、中药(龙胆泻肝丸)所致肾损害与药物剂量、疗程相关,而氨苄西林、头孢唑林、环丙沙星所致肾损害与药物剂量、疗程无关。结论:应用有肾毒性药物时一定要注意剂量、疗程、患者的年龄及机体状态,尤其对有脱水、低蛋白血症、糖尿病、肾脏病史的患者,以及老年和儿童患者。用药期间须密切观察尿常规、尿酶及肾功能变化,争取早期发现,及时肾活检确诊,采取有效措施,防止病情进展。

Drug-induced renal impairment:clinical and pathological analysis of 25 cases

Objective: To observe the clinical manifestations and pathological chan ges of drug-induced renal impairment. Method: 25 cases with drug-induced renal i mpairment were analysed retrospectively, who were confirmed clinically and patho logically. Results: 25 cases included both acute (20) and chronic (5) renal fail ure. In former there were acute renal tubular necrosis (13) and acute interstiti al nephritis (7). And their outcomes were deaths (2), recovered (15) and chronic (3). In latter all 5 cases were chronic interstitial nephritis, resulting in 3 deaths. The renal impairment related to dosage and couse of treatment for follow ing drugs: gentamicin, contrast media, cisplatin, methotrexate, NSAIDs, longdanx ieganwan, while no such relations were found in ampicillin, cefazolin, ciproflox acin. Conclusion: Dosage and course of the above-mentioned drugs for treatment should be cautioned, together with consideration of patients' age and physical condition, such as dehydration, hypoproteinemia, diabetes, nephrosis, the elderl y and children in particular.