长期服用布洛芬致镇痛剂肾病

Analgesic nephropathy caused by long-term administration of ibuprofen

1例51岁男性患者因腰腿疼痛间断服用布洛芬4年,因疼痛加重规律服用该药(0.2 g、3次/d)2年后出现恶心、呕吐,实验室检查示红细胞计数2.13×1012/L,血红蛋白(Hb)59 g/L,血清肌酐(Scr)897μmol/L,尿酸457μmol/L,尿蛋白(+);腹部CT检查示双肾体积减小,表面凹凸不平,肾乳头钙化。诊断:慢性肾脏病5期。根据用药史与临床体征,考虑其慢性肾脏病可能与长期服用布洛芬有关。停用布洛芬,给予禁饮食、颈静脉临时插管血液透析和纠正贫血等对症处理,同时建立有效的血管通路以备进行血液透析。7 d后予流质饮食鼻饲,患者未出现腹胀、恶心、呕吐等症状;22 d后予半流质饮食;27 d后,患者Scr 531 mmol/L,Hb 84 g/L。嘱患者禁用布洛芬等有肾毒性的药物,需要时可口服对乙酰氨基酚(最大日剂量≤3 g)或使用局部镇痛贴剂。

A 51-year-old male patient received ibuprofen intermittently for loin and leg pain for 4 years and regularly(0.2 g,thrice daily)due to the aggravation of pain for 2 years.Then the patient developed nausea and vomiting.Laboratory tests showed red blood cell count 2.13×1012/L,hemoglobin(Hb)59 g/L,serum creatinine(Scr)897μmol/L,uric acid 457μmol/L,and urine protein(+).Abdominal CT scan showed that both kidneys were with reduced volume,uneven surface,and papillary calcification.The patient was diagnosed with chronic kidney disease stage 5.It was considered that the patient′s chronic kidney disease might be associated with long-term administration of ibuprofen,according to his medication history and clinical presentations.Ibuprofen was discontinued immediately and the patient was given symptomatic treatments including fasting,temporary hemodialysis via jugular vein cannulation,and remedying anemia.Meanwhile,the efficient vascular access was established for long-term hemodialysis.After 7 days,the patient was fed with liquid diet through nasal feeding tube and no symptoms like abdominal distention,nausea,or vomiting appeared.After 22 days,semi-fluid diet was given.After 27 days,his Scr was 531 mmol/L and Hb was 84 g/L.The patient was told not to take nephrotoxic drugs such as ibuprofen,and if necessary,oral acetaminophen(maximum daily dose≤3 g)and analgesic patches for topical use were recommended.