头孢曲松致梗阻性、肾性急性肾损伤的病例报道及其临床路径的建立

Case Reports of Ceftriaxone-induced Obstructive and Renal Acute Kidney Injury and Establishment of Its Clinical Pathway

目的:探讨头孢曲松致梗阻性、肾性急性肾损伤(AKI)的临床表现及其临床路径的建立。方法:对西安交通大学第一附属医院(简称"我院")发生的2例头孢曲松致AKI(1例梗阻性AKI,1例肾性AKI)进行报道;检索PubMed、中国知网、万方数据及维普网等数据库1997年1月-2017年12月头孢曲松致梗阻性、肾性AKI的相关文献并分析其发生时间及临床表现等;然后根据分析结果,建立头孢曲松致梗阻性、肾性AKI的临床路径。结果:报道的梗阻性/肾性AKI患者因"咽喉疼痛""/间断下腹疼痛"静脉滴注头孢曲松导致AKI,分别于我院治疗6周、6个月后肾功能恢复正常。共检索到270例相关病例,头孢曲松致梗阻性、肾性AKI多发生在用药7d内,且男性多于女性;梗阻性AKI 252例(93.33%),临床表现为腰腹疼痛、少尿或无尿、肾积水或输尿管扩张,诊疗及时肾功能均可恢复正常,治愈率为100%;肾性AKI 18例(6.67%),临床表现为皮疹、血尿、蛋白尿及水肿,肾功能不易恢复,临床预后差,治愈率为27.78%。根据头孢曲松致梗阻性、肾性AKI的临床表现、发生特点、临床转归等差异,初步建立其临床路径,即梗阻性AKI去除梗阻后肾功能便可恢复,肾性AKI无禁忌者应进行肾活检以明确病理类型,对症治疗后肾功能无缓解者,应考虑糖皮质激素治疗或联合免疫抑制剂治疗。结论:建立的头孢曲松致梗阻性、肾性AKI临床路径,可为临床医师快速鉴别与诊疗提供参考。

OBJECTIVE:To investigate the clinical manifestations and pathway of ceftriaxone-induced obstructive and renal acute kidney injury(AKI).METHODS:Two cases of ceftriaxone-induced AKI(one case of obstructive AKI and one case of renal AKI)in the First Affiliated Hospital of Xi’an Jiaotong University(called“our hospital”for short)were reported.Retrieved from PubMed,CNKI,Wanfang database,VIP and other databases during Jan.1997-Dec.2017,related literatures about ceftriaxone-induced obstructive and renal AKI were collected;occurrence time and clinical manifestations of them were analyzed.Based on above results,clinical pathway was established for ceftriaxone-induced obstructive and renal AKI.RESULTS:Renal function of patients with obstructive and renal AKI,which were induced by intravenous drip of ceftriaxone for“throat pain”/“intermittent lower abdominal pain”,renal function returned to normal after treatmenting 6 weeks and 6 months in our hospital respectively.A total of 270 cases were retrieved;ceftriaxone-induced obstructive and renal AKI mainly occurred within 7 d of treatment,and male was more than female.There were 252 cases of obstructive AKI(93.33%),mainly manifesting as lumbar abdominal pain,oliguria or urinuria,hydronephrosis or ureteral dilatation;renal function could return to normal if diagnosing and treating timely,with cure rate of 100%.There were 18 cases of renal AKI(6.67%),manifesting as rash,hematuria,proteinuria and edema;renal function was not easy to recover;clinical prognosis was poor with cure rate of 27.78%.According to the difference of clinical manifestations,occurrence charateristic,clinical outcome,the clinical pathway was established,that is,renal function can be restored after removal of obstructive AKI obstruction,renal biopsy should be performed in patients with no contraindication of renal AKI to determine the pathological type,and glucocorticoid therapy or combined immunosuppressive therapy should be considered in patients with no remission of renal function after symptomatic treatment.CONCLUSIONS:The clinical pathway for ceftriaxone-induced obstructive and renal AKI is preliminarily established so as to provide reference for rapid identification and diagnosis of clinicians.