木通中毒的肾脏损害

CHINESE HERB NEPHROPATHY:EXPERIENCE OF THREE CASES OF NEPHROTOXICITY CAUSED BY AKEBIA QUINATA

目的：了解中药木通中毒肾脏损害患者的临床病理特点及近期预后。 方法：回顾性分析３ 例木通中毒肾脏损害患者的临床表现，肾活检病理资料及转归情况。 结果：３ 例患者均是在服用１ 剂木通（ 分别为３０ｇ ，１０ｇ 及５０ｇ） 汤剂后发病，其中２ 例急性中毒，１ 例在服药６ 月后才明确诊断，早期主要临床表现为：①消化道症状（３／３ 例） ，非少尿型肾功能减退（３／３ 例） 及低钾血症（２／３ 例） 。②肾脏损伤除肾功能减退外（ＳＣｒ 分别达４１７ ，１９２０ 及３５１ μｍ ｏｌ／Ｌ） ，３ 例都有尿ＮＡＧ 酶及溶菌酶升高，尿渗量降低及尿酸化功能异常，２／３ 例有肾性糖尿。③肾脏病理变化主要是肾小管变性坏死，伴轻度肾小球及间质血管病变，细胞浸润不突出。④３ 例随访至少８ 个月以上，ＳＣｒ 仍分别为及１５１ ，１６１ 及２２３ μｍｏｌ／ Ｌ。 结论：单剂大量木通即可中毒致肾功能减退，其临床表现病理变化具有一定特点。

To report our experience of 3 cases of toxic nephropathy caused by Akebia Quinata (a Chinese herb). METHODOLOGY A retrospective study of 3 cases of Akebia Quinata nephrotoxicity was made.Clinical and pathological(of renal biopsy)data were collected and analyzed. RESULTS All of the three patients were administered with one intake of Chinese herb medicine(Akebia Quinata,at dosage of 30g,10g,and 50g respectively)for the treatment of urinary stone.The early clinical manifestation included nausea,vomiting,hypokalaemia and metabolic acidosis.Renal manifestations of Akebia Quinata nephrotoxicity included non oliguric acute renal failure,increased urinary excretion of lysosomes and N acetyl beta D glucosaminidase (NAGase),decreased urinary osmolarity,glucosuria and renal tubular acidosis.Pathological findings in renal biopsy included acute tubular necrosis,acute interstitial nephritis,a few interstitial infiltration of inflammatory cells,and minimal mesangial proliferative lesion in the glomeruli.In the follow up of the patients,chronic increase in serum creatinine level was observed. CONCLUSION Over dosage of Akebia Quinata may cause nephrotoxicity in patients with urinary stone.Unique clinical and pathological features were associated with Akebia Quinata nephrotoxicity.