万古霉素致移植肾急性肾小管坏死一例分析

Vancomycin-associated Acute Kidney Tubular Necrosis in Renal Allograft:Report of One Case

患者,男,49岁,主因肾移植术后6个月,发热5 h入院。入院后综合实验室检查和病情诊断为双肺感染,给予抗感染治疗效果差,行经鼻纤维支气管镜肺灌洗并根据肺灌洗液细菌培养及药敏试验结果使用万古霉素。用药第3天病情好转但出现尿量减少、血压升高,考虑为急性排斥反应给予甲泼尼龙琥珀酸钠冲击治疗后尿量未见增加。行移植肾活检提示:急性肾小管坏死、急性过敏性肾小管间质性肾炎,考虑为药源性。停用万古霉素改用利奈唑胺及血液透析治疗,停药14 d后患者尿量逐渐增加肾功能恢复正常,痊愈出院。

A 49-year-old men was admitted due to 5-hour fever.He underwent kidney transplantation 6 month ago.He was diagnozed as infection in both two lungs upon admission examinations.Initial treatment with anti-infection drugs showed poor results.Vancomycin was then applied based on the lung lavage and drug-sensitivity test results.After 3 days of treatment with vancomycin,the symptoms were somehow relieved,but accompanied by less urine and higher blood pressure.It was preliminarily considered as acute rejection,and methyl prednisolone acetate was applied.However,the volume of urine did not increase.Biopsy of the kidney graft showed acute kidney tubular necrosis and acute allergic tubulointerstitial nephritis,which were believed to be drug-associated.Vancomycin was stopped,and linezolid and haemodialysis were applied.Fourteen days later,the volume of urine gradually increased and the renal function returned normal,and the patient was discharged.