文档介绍：药物性肾损害
2008年安全评价人员教育培训
常见有肾损害倾向的药物分类
抗生素类:氨基糖甙类、头孢菌素类、青霉素类等。
非甾体类消炎药:水杨酸类如乙酰水杨酸，类***类如乙酰***基酚，吡唑***类如保泰松，有机酸类如吲哚美辛、布洛芬等积。
drug-induced AIN HE 400
drug-induced AIN PAS 250
drug-induced ATN HE 250
NSAID-induced AIN HE 250
治 疗
及时停药
应用泼尼松及免疫抑制剂： 实验和临床资料显示 steroid and cytotoxic therapy 可能有效。无对照试验。
Prednisone ： 1 mg/kg per day or 2 mg/kg every other day.
in patients with severe renal failure： Pulse intravenous methylprednisolone (1 g/day for three days).
Cyclophosphamide or other immunosuppressive agent (eg, MMF) :
1. No improvement in the SCr after 2-3 wks of steroid therapy
2. CTX : 2 mg/kg per day
3. diagnosis should be confirmed by renal biopsy .
4. little documented evidence to support the efficacy of immunosuppressive agents other than corticosteroids and their use is rarely required.
Duration : generally 2-3 mons, with gradual tapering being begun after the plasma creatinine concentration has returned to or near the previous baseline.
Advanced chronic disease ( Marked interstitial fibrosis, tubular atrophy, and little acute inflammation ): Immunosuppressive therapy is not likely to be effective and probably should be withheld .
Plasmapheresis:
prednisone and cyclophosphamide治疗的补充
指征：in the rare patient with
the interstitial nephritis seems to be induced by deposition of circulating antibodies against the tubular basement membranes
IF： IgG 线样沿肾小管基底膜沉积
No proof that this modality is effective in this setting.
大多患者在停用可疑药物，或使用prednisone治疗后可恢复。
大多在开始的6~8周内有所恢复。
可能是不完全恢复，即血肌酐持续在基础值之上。
复****发表的文献， mg/dL (110 和 150 µmol/L) 仅 49 % 和68% 。（it is not clear what the baseline values were）
(Rossert, J. Drug-induced acute interstitial nephritis. Kidney Int 2001; 60:804. )
预 后
抗菌药物引起的肾损害
氨基糖甙类
青霉素类
头孢菌素类
磺***类药物
利福平
二性霉素B
特 点
约90%以上以原形经肾小球滤过排出，正常其半衰期为2-3h，当肾功能减退时显著延长。血液透析可清除大部分药物及代谢产物，但腹膜透析对其清除作用较弱。 (耳毒性! )
与剂量和疗程相关
毒性的大小顺序：庆大霉素>妥部霉素>阿米卡星>奈替米星
临床特点：用药后5～7日起病，7～10日肾毒性最强；非少尿型ARF；肾功能恢复慢（2-5周）；