阿昔洛韦过量致急性肾衰竭诊治分析

Acyclovir-induced acute renal failure and a review of the literature

目的探讨阿昔洛韦过量导致急性肾功能衰竭的组织学特点、临床表现、治疗以及预后。方法报告1例阿昔洛韦过量导致的急性肾功能衰竭患者的临床、病理及预后资料,系统复习相关文献进行讨论。结果患者中年男性,因右侧颈背部"带状疱疹"给予阿昔洛韦静滴联合口服治疗,于每次静滴半小时内出现突发腰痛、下腹坠胀,治疗2d后发生尿量减少、全身不适等症状。查肾功示:血尿素氮(BUN)20.7mmol/L,血清肌酐(CRE)560.3μmol/L;肾脏病理检查示:急性肾小管坏死伴轻度系膜增生及个别肾小球硬化。给予停药、紧急血液透析2次及对症支持治疗7d后痊愈。结论阿昔洛韦导致肾功能衰竭最常见症状是突发腰痛、恶心,病理学多为肾小管病变,患者经过停药、透析及对症支持治疗后均能痊愈。

Objective To investigate the histological features,clinical manifestations,treatment options and prognosis of Acyclovir-induced acute renal failure.Methods The clinical,pathological and prognosis of 1 case of Acyclovir-induced acute renal failure were reviewed respectively,and the related literature was reviewed.Results A middle-aged man suffering from cutaneous herpes zoster was given Acyclovir by intravenous drip and per os,when he developed acute abdominal pain and general malaise.Renal examin on showed,his serum creatinine（CRE） and blood urea nitrogen（BUN） concentrations rose to 560.3 μmol/L and 20.7 mmol/L,respectively.The pathology of kidney exhibited acute renal tubular necrosis acompanied with slight glomerular sclerosis.Renal impairment was restored after discontinuation of Acyclovir,hemodialysis and symptomatic treatment.Conclusion Acute abdominal pain and nausea are the most common symptoms of Acyclovir-induced acute renal failure.The pathology revealed acute renal tubular necrosis.Hemodialysis,symptomatic treatment and discontinuation of Acyclovir are the effective treatment.