Rutkowski Bolesław
Katedra i Klinika Nefrologii, Transplantologii i Chorób Wewnetrznych Akademii Medycznej w Gdańsku.
Pol Merkur Lekarski. 2010 Jan;28(163):66-70.
Iatrogenic kidney diseases may appeared as the consequence of medical mistakes or as the result of drug side effects. Present paper is dedicated mainly to this second group of disorders. Spectrum of different syndromes caused by the undesirable drug effects is very long and varied. There are among them water and electrolyte, disorders, tubulo-interstitial nephritis, glomerulopathies or acute renal failure. Also list of potentially nephrotoxic drugs is very long and including many different medicines. Additionally it is important to take into account existence of many risk factors enabling appearance of drug nephrotoxicity. Most important seen to be advanced age and deterioration of renal function. Main prophylactic method preventing development of drug induced nephropaties is strict drug dosage, their adjustment according glomerular filtration rate and monitoring of water- electrolyte balance. Common automatic estimation of eGFR by diagnostic laboratories have to be useful tool in this matter. It is also important to avoid combinations of potentially nephrotoxic drugs. In case of the appearance of first symptoms of toxic renal injury specific activities dependent from the character and severity of pathological changes are necessary. Nevertheless most important issue is consciousness of this danger in both sides: physician and patients enabling avoid drug nephrotoxicity.
医源性肾脏疾病可能是医疗失误的后果,也可能是药物副作用的结果。本文主要致力于研究这第二类病症。由不良药物作用引起的不同综合征范围非常广泛且各不相同。其中包括水和电解质紊乱、肾小管间质性肾炎、肾小球病或急性肾衰竭。此外,潜在肾毒性药物的清单也很长,包括许多不同的药物。另外,考虑到许多导致药物肾毒性出现的危险因素的存在很重要。最重要的似乎是高龄和肾功能恶化。预防药物性肾病发展的主要预防方法是严格控制药物剂量,根据肾小球滤过率进行调整,并监测水电解质平衡。诊断实验室对估算肾小球滤过率(eGFR)的常规自动检测在这方面必须是有用的工具。避免使用潜在肾毒性药物的联合用药也很重要。如果出现毒性肾损伤的最初症状,根据病理变化的性质和严重程度进行特定的治疗活动是必要的。然而,最重要的问题是医生和患者双方都要意识到这种危险,从而避免药物肾毒性。