雷贝拉唑致急性肾损伤的文献分析

Literature Review on Acute Interstitial Nephritis Induced by Rabeprazole

目的:总结雷贝拉唑致急性肾损伤(AKI)的临床特点,为临床安全使用雷贝拉唑提供参考。方法:检索MEDLINE、中国知网、万方数据库和维普数据库中建库至2021年7月6日发表的关于雷贝拉唑致AKI的病例报告,对相关数据进行统计和描述性分析。结果:最终纳入7篇文献,病例共7例,其中5例为急性间质性肾炎,1例为急性肾小管坏死,1例为横纹肌溶解引起AKI。患者年龄分布于57~84岁[平均(66.6±10.1)岁];男性患者4例(占57.1%),女性患者3例(占42.9%);雷贝拉唑日剂量主要为10~20 mg,仅1例患者日剂量为40 mg;用药疗程为2 d至6个月;雷贝拉唑致AKI的临床特点通常为疲劳、恶心、尿隐血、蛋白尿、贫血、血肌酐水平升高及血尿素氮水平升高等;发生AKI患者的血肌酐水平为113~469μmol/L[平均(267.7±107.7)μmol/L];其中5例患者使用糖皮质激素治疗,随访10 d至18个月,血肌酐水平恢复至97~150μmol/L[平均(118.5±21.5)μmol/L]。结论:雷贝拉唑所致AKI主要为急性间质性肾炎,临床使用时应严格把握其适应证,监测患者血肌酐水平。

OBJECTIVE:To summarize the clinical characteristics of acute kidney injury(AKI)induced by rabeprazole,so as to provide reference for the safe use of rabeprazole in clinic.METHODS:MEDLINE,CNKI,Wanfang Data and VIP database were retrieved to collect the case reports of AKI induced by rabeprazole,the retrieval time was from the establishment of the database to Jul.6 th,2021.Statistical and descriptive analysis was performed on relevant data.RESULTS:Seven literatures were included,with a total of 7 cases,including 5 cases of acute interstitial nephritis,1 case of acute tubular necrosis,and 1 case of AKI was induced by rhabdomyolysis.The patients ranged in age from 57 to 84 years old[mean(66.6±10.1)years old],with 4 males(57.1%)and 3 females(42.9%).The daily dose of rabeprazole was from 10 mg to 20 mg,only one case was 40 mg,and the treatment course ranged from 2 d to 6 months.Clinical characteristics of AKI induced by rabeprazole were mainly fatigue,nausea,hematuria,proteinuria,anemia,elevated blood creatinine levels and elevated blood urea nitrogen levels.Serum creatinine levels in patients with AKI ranged from 113μmol/L to 469μmol/L[mean(267.7±107.7)μmol/L].Five patients were treated with glucocorticoid and followed up for 10 d to 18 months,the serum creatinine levels recovered to 97μmol/L to 150μmol/L[mean(118.5±21.5)μmol/L].CONCLUSIONS:AKI induced by rabeprazole is mainly acute interstitial nephritis,and its indications should be strictly controlled in clinical use,and the serum creatinine level of patients should be monitored.