81例药物性急性肾衰竭临床分析

The clinical analysis of 81 cases with drug-induced acute renal failure

目的 总结我院药物所致的急性肾衰竭 (ARF)的发生、临床病理改变、治疗及预后 ,为临床合理用药、最大程度避免药物性ARF的发生提供客观依据。方法 收集我院 410例ARF患者 ,并分析药物所致不同ARF的发生率、预后转归和涉及药物的种类。结果 药物性ARF患者81例 ,占同期收集ARF患者总数 19.8% ,其中男性 5 3例 ,女性 2 8例 ,平均年龄 ( 4 9.74± 19.14 )岁 ,>60岁患者占 3 2 .1%。肾前性ARF 5例 ( 6.1% ) ,肾小管间质病变 72例 ( 88.9% ) ,肾小球血管病变和肾内梗阻各 2例 ( 2 .5 % )。肾活检 2 4例 ,均为肾小管间质病变 ,70 .8%为肾小管坏死。涉及药物中抗生素占首位 ( 3 9.5 % ) ,其中氨基糖甙类抗生素为主要病因 ,其次为造影剂 ( 11.1% )和甘露醇 ( 7.4% ) ,16%患者为 2种或 2种以上药物联合使用。内科组 >60 %患者存在内科基础疾病。2 7.2 %患者需血液净化治疗。药物性ARF治愈率 82 .7% ,与药物直接相关的死亡率 8.6%。结论 ARF病因已发生改变 ,药物因素在本组资料中占首位 ;中老年药物性ARF发生率高于年青者 ;合并内科基础疾病者发生率高 ;抗生素 (主要是氨基糖甙类 )和造影剂是主要的致病因素 ;药物性ARF早期诊断和防治能明显改善预后 。

Objective To investigate the incidence of drug induced acute renal failure(ARF)and analyze its clinical manifestations and prognosis in a prospective study on ARF.Methods 81 patients with drug induced 410 patients ARF admitted in our hospital were collected from 1998.7 to 2002.12.These patients were devided into two types:pre renal and renal parenchymal ARF.Their etiology and prognosis were analyzed.Results Of all the patients with ARF found in this period,81 patients(19.8%) were drug induced ARF.Among them,fifty three was male and twenty eight female,mean age 49.74± 19.14 years old. 32.1% patients were elder than 60 years.5 patients were belong to pre renal ARF (6.1%), 72 cases renal parenchymal ARF(88.9%) and 2 cases(2.5%) glomerulo vascular lesions and intra renal obstruction respectively.All 24 renal specimens showed tubular interstitial lesions,70.8% was acute tubular necrosis.Antibiotics were the head cause of drug induced ARF,then radiocontrast agents and mannitol.16% patients had been prescribed simultaneously more than one drug.27.2% patients need renal hemopurification. Mortality of drug induced ARF was 11.1% and adjusted mortality directly related to ARF was 8.6%.Conclusion The prevalence of etiology of ARF has been changed,the drug induced ARF has become the primary cause in our group.The incidence was higher in the senior than that in the junior and a higher incidence was observed in the patients with internal diseases.Antibiotics and radiocontrast agents were the main causes.Early diagnosis has played an important role not only in the treatment,but also in the improvement of prognosis and increase the survival rate.