肾毒性药物致移植肾急性损伤误诊为急性排斥反应

Disfunction of Transplanted Kidney Induced by Drugs: a Report of Two Cases and Literature Review

目的探讨药物致移植肾失功能的临床表现及诊治要点,以提高临床对本病的认识,减少误诊误治。方法对2例因肾毒性药物所致移植肾失功能患者的临床资料进行回顾性分析,并复习相关文献。结果 2例均为肾移植术后肺部感染男性患者,均停用免疫抑制剂,予万古霉素抗感染治疗,其中1例加用两性霉素B。用药15 d、20 d后均出现移植肾失功能,临床表现为尿量减少、血肌酐升高,均诊断为急性排斥反应,予抗排斥治疗无效,后通过病理检查排除急性排斥反应,经综合分析诊断为药物所致移植肾失功能。1例停用万古霉素后移植肾功能逐渐恢复,另1例因移植肾功能无法恢复而予以切除。结论肾毒性药物致移植肾失功能症状缺乏特异性,易误诊,故临床应加强对此病的认识,病理检查是准确诊断并指导治疗的关键所在。

Objective To explore clinical manifestations and the key points of treatment of disfunction of transplanted kidney induced by drugs so as to enhance awareness and reduce misdiagnosis rate. Methods Clinical data of 2 cases of disfunction of transplanted kidney induced by the renal toxicity drugs was retrospectively analyzed,and pertinent literature was also reviewed. Results Two male patients had pulmonary infection after kidney transplantation,and were treated with Vancomycin including one added with Amphotericin B as anti-infective therapy after immunosuppressive agents were stopped. Disfunction of transplanted kidney was found after the 15th and 20th d of pharmacotherapy. The patients mainly had hypourocrinia and serum creatinine increase,and were misdiagnosed as having acute rejection,but anti-rejection treatment was ineffective,and acute rejection was denied after pathological examination,and then disfunction of transplanted kidney induced by drugs was confirmed. One patient＇s renal function recovered after use of Vancomycin was stopped,and transplanted kidney of another patient was excised due to failure of recovery of renal function. Conclusion Disfunction of transplanted kidney induced by the renal toxicity drugs is lack of specific symptoms and can easily be misdiagnosed. Clinicians should enhance awareness of the disease,and pathological examination is key to definite diagnosis and treatment.