恒格列净致急性肾衰竭

Acute kidney failure induced by henagliflozin

1例45岁男性2型糖尿病患者因血糖控制不佳、高血压病、高脂血症等在门冬胰岛素30和阿卡波糖治疗的基础上加用恒格列净(10 mg、1次/d)、依那普利、非诺贝特、非奈利酮、塞来昔布、乙哌立松和甲钴胺。加用药物前,患者血清肌酐(Scr)和血尿素氮(BUN)无异常。因其他症状相继好转,患者自行停用塞来昔布、非奈利酮和非诺贝特。用药第36天,患者腰部出现阵发性疼痛,逐渐加重,2 d后患者自行停用恒格列净(其余药物不变),次日实验室检查示Scr 180μmol/L、BUN 9.6 mmol/L,诊断为急性肾衰竭。给予止痛、解痉、激素冲击治疗,患者腰部疼痛逐渐好转。停用恒格列净第6天,Scr 142μmol/L、BUN 9.4 mmol/L;停药第9天,Scr 113μmol/L、BUN 9.1 mmol/L;停药约3个月后,Scr 66μmol/L、BUN 6.0 mmol/L。

A 45-year-old male patient with type 2 diabetes mellitus was additionally treated with henagliflozin(10 mg,once daily),enalapril,fenofibrate,finerenone,celecoxib,eperisone and mecobalamin due to poor glycemic control,hypertension,hyperlipidemia and other conditions at previous therapy of insulin aspart 30 and acarbose.Before the additional medication,the patient′s serum creatinine(Scr)and blood urea nitrogen(BUN)were normal.,Later,the patient discontinued celecoxib,finerenone,and fenofibrate by himself as relevant symptoms were improved successively.On the 36th day of medication,the patient experienced paroxysmal pain in the lumbar region,which gradually worsened.Then the patient stopped using henagliflozin by himself 2 days later while the other medications remained.The next day,laboratory tests indicated Scr 180μmol/L and BUN 9.6 mmol/L,and acute kidney failure was diagnosed.Analgesic,antispasmodic and glucocorticoid pulse therapy was administered,and the patient′s lumbar pain was gradually improved.On the 6th day of discontinuing henagliflozin,Scr was 142μmol/L and BUN was 9.4 mmol/L;on the 9th day,Scr was 113μmol/L and BUN was 9.1 mmol/L;approximately 3 months after drug discontinuation,Scr was 66μmol/L and BUN was 6.0 mmol/L.