Obada Erika Nnang, Level Gérard, Mathieu Pierre, Parent Xavier, Gilson Brigitte, Bindi Pascal
Centre hospitalier, nephrologie, 2, rue d'Anthouard, 55107 Verdun, France.
Nephrol Ther. 2010 Apr;6(2):125-7. doi: 10.1016/j.nephro.2009.12.001. Epub 2010 Feb 4.
The antiviral molecule acyclovir can be responsible of severe renal dysfunction. Intratubular crystal precipitation of the drug may represent a major pathogenetic mechanism.
A 30-year old, immunocompetent woman was admitted in the neurology unit for a viral meningo-encephalitic syndrome. Intravenous acyclovir was delivered at the dose of 45 mg/kg per day. Despite a neurological improvement, she developed an acute renal insufficiency with the serum creatinine increasing from 63 to 385 micromol/L within 12 days. The urine study revealed great amounts of birefringent crystals which were typical of acyclovir derived crystals according to the spectrophotometric examination. Withdrawal of acyclovir treatment in combination with oral and parenteral hydration resulted in a complete recovery of the renal function. The conditions favouring acyclovir-induced nephrotoxicity are discussed.
抗病毒分子阿昔洛韦可导致严重的肾功能障碍。药物在肾小管内的晶体沉淀可能是主要的发病机制。
一名30岁免疫功能正常的女性因病毒性脑膜脑炎综合征入住神经内科。静脉注射阿昔洛韦，剂量为每天45mg/kg。尽管神经症状有所改善，但她出现了急性肾功能不全，血清肌酐在12天内从63μmol/L升至385μmol/L。尿液检查发现大量双折射晶体，根据分光光度检查，这些晶体是阿昔洛韦衍生晶体的典型特征。停用阿昔洛韦治疗并结合口服和静脉补液后，肾功能完全恢复。本文讨论了有利于阿昔洛韦诱导肾毒性的条件。
