阿莫西林、呋喃唑酮、雷贝拉唑和铋剂联用治疗幽门螺杆菌感染致急性肾损伤

Acute kidney injury due to combination therapy with amoxicillin,furazolidone,rabeprazole,and bismuth for Helicobacter pylori infection

1例58岁男性患者接受四联疗法治疗幽门螺杆菌感染,给药方案为口服阿莫西林(1 g,2次/d)、呋喃唑酮(0.1 g,2次/d)、雷贝拉唑(20 mg、2次/d)和枸橼酸铋钾(0.6 g、2次/d),共用药4周。停药7 d后实验室检查示血肌酐(Scr)469μmol/L,尿素氮(BUN)19.2 mmol/L;肾组织活检病理检测结果提示急性肾小管损伤。患者半年前体检结果显示Scr 78μmo/L。考虑患者的急性肾损伤与四联疗法有关。给予甲泼尼龙、瑞巴派特和碳酸钙口服。4周后复查,Scr 171μmol/L,BUN 14.4 mmol/L,继续上述治疗;12周后复查,Scr 140μmol/L,BUN 11.4 mmol/L。

A 58⁃year⁃old male patient received quadruple therapy with amoxicillin 1 g,furazo⁃lidone 0.1 g,rabeprazole 20 mg,and bismuth potassium citrate 0.6 g twice daily for Helicobacter pylori infec⁃tion for 4 weeks.Seven days after drug withdrawal,the laboratory tests showed serum creatinine(Scr)469μmol/L and blood urea nitrogen(BUN)19.2 mmol/L.Renal biopsy showed acute tubular injury.The Scr level was 78μmol/L in the physical examination of 6 months ago.Acute kidney injury was considered to be associated with the quadruple therapy.Methylprednisolone,rebamipide,and calcium carbonate were given orally.Four weeks later,the laboratory tests showed Scr 171μmol/L and BUN 14.4 mmol/L and the above treatments were continued;12 weeks later,his Scr was 140μmol/L and BUN was 11.4 mmol/L.