Karamadoukis L, Shivashankar G H, Ludeman L, Williams A J
The Richard Bright Renal Unit, Southmead Hospital, Bristol, United Kingdom.
Clin Nephrol. 2009 Apr;71(4):430-2. doi: 10.5414/cnp71430.
We report an unusual complication of orlistat, a gastrointestinal and pancreatic lipase inhibitor used in the treatment of obesity. A 66-year-old man with history of Type 2 diabetes and obesity presented to our hospital with recurrent episodes of hypoglycemia over 2 weeks. His medications included twice daily biphasic insulin and 3 months previously he was prescribed orlistat as treatment for his obesity. On admission he was in acute renal failure with a creatinine concentration of 405 micromol/l. His renal function 4 months previously was normal. Urinalysis revealed neither blood nor protein, but microscopy of his urine revealed moderate amounts of crystals. A renal biopsy revealed normal glomeruli, but there were features of acute tubular necrosis associated with oxalate crystal deposition. Over the next few days his renal function declined and needed hemodialysis. 3 weeks after his admission he continued to require hemodialysis and he unexpectedly had a cardiac arrest and died. Our patient had acute tubular necrosis secondary to orlistat-induced acute oxalate nephropathy. The identification of high risk patients treated with orlistat and regular monitoring of their renal function might reduce the risk of renal failure due to acute oxalate nephropathy.
我们报告了一例奥利司他（一种用于治疗肥胖症的胃肠道和胰腺脂肪酶抑制剂）的罕见并发症。一名66岁的男性，有2型糖尿病和肥胖病史，因在2周内反复出现低血糖发作前来我院就诊。他的药物治疗包括每日两次的双相胰岛素，3个月前他开始服用奥利司他治疗肥胖症。入院时他处于急性肾衰竭状态，肌酐浓度为405微摩尔/升。他4个月前的肾功能正常。尿液分析未发现血尿和蛋白尿，但尿液显微镜检查发现有中等量的结晶。肾活检显示肾小球正常，但存在与草酸盐结晶沉积相关的急性肾小管坏死特征。在接下来的几天里，他的肾功能恶化，需要进行血液透析。入院3周后，他仍需要继续进行血液透析，且意外发生心脏骤停并死亡。我们的患者患有奥利司他诱导的急性草酸盐肾病继发的急性肾小管坏死。识别接受奥利司他治疗的高危患者并定期监测其肾功能，可能会降低因急性草酸盐肾病导致肾衰竭的风险。
