合并使用咪唑立宾及贝那普利诱发高尿酸血症伴急性肾损伤1例报告并文献复习

Mizoribine and benazapril-associated hyperuricemia and acute kidney injury:a case report with review of the literature

目的探讨咪唑立宾(MZR)诱发高尿酸血症及急性肾损伤(AKI)的临床特点及发病机制。方法回顾分析1例合并使用MZR及贝那普利诱发高尿酸血症伴AKI的IgA肾病患儿的临床资料。结果男性患儿,13岁,确诊IgA肾病5个月,基础肾功能无异常,合并使用MZR和贝那普利后出现一过性高尿酸血症和AKI,尿酸清除率明显降低至3.66 mL/(min·1.73 m^(2)),尿钠排泄分数<1(0.4%),尿酸排泄分数代偿性增加至17.1%,高度提示肾前性AKI。停用上述药物,给予水化治疗后,患儿肾功能迅速恢复。结论MZR导致的高尿酸血症除阻塞肾小管引发肾后性AKI外,还可通过减少肾脏灌注引发肾前性AKI。

Objective To investigate the clinical characteristics and pathogenesis of hyperuricemia and acute kidney injury(AKI)induced by mizoribine(MZR).Methods The clinical data of a case of IgA nephropathy with hyperuricemia induced by oral administration of MZR was retrospectively reviewed.Results A 13-year-old boy with IgA nephropathy was diagnosed for 5 months.The basic renal function was normal.Transient hyperuricemia and acute renal injury were found after combined use of benazepril and MZR.The uric acid clearance rate(UACl)was significantly reduced to 3.66 mL·min^(-1)·1.73 m^(-2),the fractional excretion of sodium(FENa)was less than one(0.4%),and the fractional excretion of uric acid(FEUA)was increased to 17.1%,highly suggestive of pre-renal AKI.After stopping the above drugs,he received hydration treatment,then the renal function recovered rapidly.Conclusion Hyperuricemia induced by MZR can not only cause post-renal AKI,but also reduce renal perfusion.When combined with angiotensin converting enzyme inhibitor,the effect of MZR on uric acid metabolism and the adverse reactions should be found in time for further adjustment of the medication.