[上海药物性急性肾衰竭分析]

[Analysis of drug-induced acute renal failure in Shanghai].

作者信息

Che Miao-lin, Yan Yu-cheng, Zhang Yun, Gu Yong, Wang Nian-song, Chen Nan, Mao Pei-ju, Zhang Jin-yuan, Ding Xiao-qiang, Yuan Wei-jie, Mei Chang-lin, Yao Jian, Fan Yu-liang, Zhou Yi, Zhang Wei, Zhu Han-wei, Liu Mei, Jin Hui-min, Qian Jia-qi

机构信息

Department of Nephrology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2009 Mar 24;89(11):744-9.

PMID:19595102

Abstract

OBJECTIVE

To investigate the incidence and prognosis of drug-induced acute renal failure (ARF) in Shanghai.

METHODS

The registration forms of ARF patients admitted in 17 hospitals of and over the middle class in Shanghai from January 1, 2004 to December 31, 2006 were screened prospectively. The data, such as epidemiology, survival, mortality, and morbidity were analyzed.

RESULTS

347 of the 1200 ARF patients (28.9%), 224 males and 123 females, aged (58+/-20), suffered from drug-induced ARF. 51.0% of the 347 patients were older than 60. 60.2% of the drug-induced ARF in the non-surgical departments were community-acquired, while 55.7% of the drug-induced ARF in the surgical departments were hospital-acquired. Among the non-surgical departments, the incidence of hospital-acquired drug-induced ARF was the lowest in the department of nephrology (9.5%), while higher in the departments of hematology, cardiology, and neurology, and among the surgical departments, it was the lowest in department of renal surgery, while higher in the departments of liver transplantation, neurosurgery, and cardiovascular surgery. The most common complication was chronic kidney disease (CKD) (n=69, 19.9%), followed by cerebrovascular disease (n=59, 17.0%), diabetes mellitus (n=43, 12.4%), and hypertension (n=41, 11.8%). Renal biopsy showed acute tubular necrosis (18, 37.5%), acute interstitial nephritis (11, 22.9%), and acute infectious tubulo-interstitial nephritis (6, 12.5%). Antibiotics (47.8%) were the head causes of drug-induced ARF, especially aminoglycoside (17.0%) and cephalosporins (12.7%), followed by diuretics (22.2%) and radiocontrasts (13.3%). 22.5% of the drug-induced ARF patients had used two or more drugs. 119 patients (34.3%) needed renal replacement treatment. 100 of the 347 patients (28.8%) died. 188 of the surviving patients (54.2%) had their renal function recovered completely, the renal function of 42 of them (12.1%) was recovered partially, and 17 of then (4.9%) required dialysis when discharged.

CONCLUSION

Drug-induced ARF is common with higher incidence in the patients with complications. Antibiotics, diuretic agents, and contrast medium are the main causes.

摘要

目的

调查上海地区药物性急性肾衰竭（ARF）的发病率及预后情况。

方法

前瞻性筛查2004年1月1日至2006年12月31日期间上海17家及以上中等规模医院收治的ARF患者登记表。分析流行病学、生存、死亡及发病等数据。

结果

1200例ARF患者中有347例（28.9%）为药物性ARF，其中男性224例，女性123例，年龄（58±20）岁。347例患者中51.0%年龄大于60岁。非手术科室药物性ARF的60.2%为社区获得性，而手术科室药物性ARF的55.7%为医院获得性。在非手术科室中，医院获得性药物性ARF发病率在肾内科最低（9.5%），而在血液科、心内科和神经科较高；在手术科室中，发病率在肾外科最低，而在肝移植科、神经外科和心血管外科较高。最常见的并发症是慢性肾脏病（CKD）（69例，19.9%），其次是脑血管疾病（59例，17.0%）、糖尿病（43例，12.4%）和高血压（41例，11.8%）。肾活检显示急性肾小管坏死（18例，37.5%）、急性间质性肾炎（11例，22.9%）和急性感染性肾小管间质性肾炎（6例，12.5%）。抗生素（47.8%）是药物性ARF的首要病因，尤其是氨基糖苷类（17.0%）和头孢菌素类（12.7%），其次是利尿剂（22.2%）和造影剂（碘剂）（13.3%）。22.5%的药物性ARF患者使用了两种或更多种药物。119例（34.3%）患者需要肾脏替代治疗。347例患者中有100例（28.8%）死亡。存活患者中有188例（54.2%）肾功能完全恢复，42例（12.1%）部分恢复，17例（4.9%）出院时仍需透析。