药物性肾损伤59例临床分析

Clinical Analysis:59 Cases of Kidney Injury Induced by Drugs

目的:探讨药物性肾损害的发病概况、临床特点及影响预后的因素。方法:回顾分析1987年6月至2007年6月在我院泌尿内科住院的59例药物性肾损害患者的临床资料。结果59例中急性间质性肾炎和急性肾小管坏死28例;慢性小管-间质性肾炎31例。药物所致的28例急性间质性肾炎和急性肾小管坏死患者经治痊愈者23例,转为慢性肾功能不全者2例,放弃治疗1例,死亡2例,治愈率为82.14%。对药物所致的31例慢性间质性肾炎患者(其中已经进展为慢性肾功能不全者24例)经治好转者19例,治疗无效转为替代治疗者9例,死亡3例。有效率为61.29%。结论:本研究显示药物引起的急性间质性肾炎综合征应用中医药辨证治疗配合西医的血液净化等对证治疗,可以明显改善危重患者的预后,较之单纯应用西药治疗的50%～70%的治愈率要高。而药物引起的慢性间质性肾炎中的镇痛剂肾病停用镇痛药后,应用冬虫夏草制剂、及益气养血、补肾固涩、酸甘化阴、化瘀降浊等中草药治疗后,其肾功能恶化的趋势多能趋缓,部分患者的肾功能检验指标还能得到改善;而马兜铃肾病停用相关药物后,患者的肾功能则大都继续衰退,应用上述治疗方案多无明显疗效,可在2～3年内进展至肾功能衰竭。

Objective： to approach the morbility, clinical feature and effecting prognostic factors of kidney injury induced by drugs. Methods ： the paper retrospective analyzed the 59 cases of clinical data of kidney injury induced by drugs at Uropoiesis Medical Department in 6 month, 1987 year. Results： the acute interstitial nephritides and acute tubular necrosis were 28 cases. The chronicity tubuleinterstitial nephritis were 31 cases. There were 23 cases recovery in 28 cases of acute interstitial nephritides and acute tubular necrosis induced by drugs after treatment, 2 cases transfer to chronic renal insufficiency, 1 case to give up treatment and the 2 cases death. The healing rate were 82.14%. There were 19 cases improvement after treatment in 31 cases of chronic interstitial nephritis（24 cases had progressed chronic renal insufficiency） induced by drugs, the 9 cases were turned the vicariousness treatment and 3 cases were dead. The effective rate were 61.29%. Conclusion： it could obviously improve the severity patients prognosis using Chinese medical treatment based the differentiation of symptoms and signs and going with the blood purification treatment and risen the recovery rate. The analgesic nephropathy that renal functional aggravated tendency was becoming slow in stopping pain-killer and using aweto, tonifying qi and blood, invigorate the kidney, sour-sweet herbs nourishing yin and removing stasis or descending the turbid drugs in chronic interstitial nephritis induced by drugs and some patient＇s renal function index could improve. But renopathy induced by aristolochiae, fructus that renal function could continue failure in stopping drugs. The above treatment was not obviously curative effect which could have progress renal failure during 2 - 3 years.