住院患者药源性肾损伤20例临床分析

Clinical analysis of drug-induced kidney injury in 20 inpatients

目的 了解住院患者药源性肾损伤的临床特点. 方法 回顾性分析2010年1月31日至2017年1月31日出院诊断为＂药源性肾损伤＂患者的病历资料,主要分析指标为患者一般情况、肾损伤程度、转归及引起肾损伤的可疑药物等. 结果 纳入分析的患者共20例,男性16例（80.0%）,年龄8～80岁,平均（44 ± 20）岁,女性4例（20.0%）,年龄27～71岁,平均（49 ± 22）岁;≤44岁（青年人）者11例,占55.0%;45～59岁（中年人）者4例,占20.0%;≥60岁（老年人）者5例,占25.0%.20例患者每人罹患疾病数为2～6种,其中2种者3例（15.0%）,3种者7例（35.0%）, 4种者5例（25.0%）,5种者4例（20.0%）,6种者1例（5.0%）.20例患者用药前血清肌酐（Scr）和血尿素氮（BUN）分别为56.0～132.5（89.1 ± 22.1）μmol/L和2.9～8.5（4.9 ± 1.6）mmol/L,用药后出现肾损伤时Scr及BUN分别升至128.0～506.0（241.8 ± 112.8）μmol/L和4.3～28.0（13.0 ± 5.9） mmol/L,经血液透析或护肾药物治疗后Scr和BUN分别降至52.0～439.0（174.8 ± 97.5）μmol/L和1.0～27.6（9.3 ± 7.1）mmol/L,用药后与用药前比较以及治疗后与治疗前比较,差异均有统计学意义（均P〈0.05）.20例患者均为AKI,其中1期者6例（30.0%）,2期者10例（50.0%）,3期者（急性肾衰竭期）4例（20.0%）.至出院时20例患者治愈5例,好转12例,病情无变化1例,恶化1例,死亡1例,治疗有效率为85.0%.20例肾损伤患者联用药物共29大类,用药种数为6～24（14 ± 5）种.导致患者发生肾损伤的药物共5大类12种,涉及抗菌药物（15例,其中使用了两性霉素B者12例）、免疫抑制剂（3例）、化疗药（2例）、抗病毒药（2例）、和抗痛风药（1例）等,均为说明书中明确记载可致肾损伤的药物;用药至发病时间为1～56 d,中位时间为9 d. 结论 抗菌药物尤其是抗真菌药物两性霉素B是导致院内肾损伤的主要药物,住院期间发生的药物性肾损伤均为AKI,AKI治疗效果总体较好.

Objective To understand the clinical features of drug-induced kidney injury（DIKI）in inpatients. Methods The medical records data of inpatients diagnosed as DIKI from January 31,2010 to January 31,2017 were retrospectively analyzed. The main analytic indicators included general conditions of patients,degree of renal damage,outcomes,and suspected drugs causing acute kidney injury（AKI）,and so on. Results A total of 20 patients were entered into this study,including 16 males（80.0%）at age 8 to 80 years and the average age of（44 ± 20）years,4 females（20.0%）at age 27 to 71 years and the average age of（49 ± 22）years. Eleven patients（55.0%）were≤44 years old（young people）,4 patients （20.0%）were 45-59 years old（middle-aged people）,5 patients（25.0%）were ≥60 years old（old people）. The kinds of diseases were 2 to 6 in each patient in the 20 patients. Of them,3 patients（15.0%） had 2 kinds of diseases at the same time,7 patients（35. 0%）had 3 kinds of diseases,5 patients （25.0%）had 4 kinds of diseases,4 patients（20.0%）had 5 kinds of diseases,1 patient（5.0%）had 6 kinds of diseases. The serum creatinine（Scr）and blood urea nitrogen（BUN）values in the 20 patients were 56.0-132.5（89.1 ± 22.1）μmol/L and 2.9-8.5（4.9 ± 1.6）mmol/L before medication,respectively and significantly increased to 128.0-506.0（241.8 ± 112.8）μmol/L and 4.3-28.0（13.0 ± 5.9）mmol/L after medication,respectively. After treatments with hemodialysis or renal protective drugs,the Scr and BUN values were significantly reduced to 52.0-439.0（174.8 ± 97.5）μmol/L and 1.0-27.6（9.3 ± 7.1）mmol/L, respectively. The differences of Scr and BUN levels between before medication and after medication,before treatment and after treatment were statistically significant（all P〈0.05）. All DIKI during hospita-lization were AKI. Six patients（30.0%）were in AKI stage 1,10 patients（50.0%）in AKI stage 2,and 4 patients（20.0%）in AKI stage 3（acute renal failure）. By the time of discharge,5 patients were cured,in 12 patients the condition was improved,1 patient had no change,in 1 patient the condition was deteriorated, and 1 patient died. The effective rate of treatments was 85.0%. A total of 29 kinds of drugs were used in combination in the 20 inpatients,and 6-24（14 ± 5）kinds of drugs were used in each patient. Five categories and 12 drugs were found to induce kidney injury in this study,involving antibacterial drugs （15 patients）,chemotherapeutic drugs（2 patients）,antiviral drugs（2 patients）,immunosupp-ressants （3 patients）,and anti-gout drugs（1 patient）. Kidney damage was clearly documented in the instructions of all above-mentioned drugs. The time from medication to onset of DIKI was 1-56 days and the median time was 9 days. Conclusions Antibacterial drugs,especially antifungal drugs such as amphotericin B,were the main drugs causing kidney injury in hospital. The DIKI was AKI during hospitalization,and the treatment effect for AKI was good.