肾癌患者口服依维莫司片致急性肾功能不全1例探讨

Acute renal insufficiency caused by oral everolimus in one patient with advanced kidney cancer

目的:探讨1例晚期肾癌患者口服依维莫司片发生急性肾功能不全的原因。方法:对1例口服依维莫司后出现急性肾功能不全的晚期肾癌患者的临床资料进行分析,并观察给予连续性肾脏替代疗法治疗后肾功能的改善情况。结果:患者合并肺部感染,在接受抗感染治疗及口服依维莫司后第4天出现急性肾功能不全。所用抗感染药物对肾功能影响相对较小,但依维莫司有引发急性肾功能不全的可能。患者使用的氟康唑是细胞色素P450(cytochrome P450,CYP450)超家族中CYP3A4的抑制剂,能够抑制依维莫司代谢,从而可能导致急性肾功能不全。结论:同时应用CYP3A4抑制剂可能会导致依维莫司不良反应发生率的增加,而连续性肾脏替代疗法可以治疗依维莫司导致的急性肾功能不全。

Objective： To by oral evero explore the cause of acute renal mus in one patient with advanced insufficiency induced kidney cancer. Methods： The clinical records of one advanced kidney cancer patient developing acute renal insufficiency after oral administration of everolimus and anti-infective drugs were analyzed. The renal function was observed after continuous renal replacement therapy. Results： Acute renal insufficiency occurred after treatment with everolimus for four days, while pulmonary infection was likely to get better after anti-infective treatment. There were no relevant reports about the adverse effects of anti-infective drugs, which the patient used, on the function of the kidney. There were some reports regarding the acute renal insufficiency caused by everolimus. As an inhibitor of cytochrome P450 （CYP450）, fluconazole may aggravate the renal insufficiency by inhibiting the metabolism of everolimus.Conclusion： Combination of CYP450 inhibitor and everolimus may increase the incidence of adverse reactions of everolimus, and the acute renal insufficiency caused by everolimus could be cured by continuous renal replacement therapy.