Li Zheng-hong, Wei Min, Ding Guo-fang, Wang Dan-hua
Department of Pediatrics, Chinese Academy of Medical Sciences, Beijing, China.
Zhonghua Er Ke Za Zhi. 2011 Nov;49(11):814-7.
To summarize the clinical characteristics and prognosis of newborn aristolochic acid nephropathy induced by akebia.
Retrospective analysis of clinical manifestations, therapy and prognosis was made upon data of 3 newborn infants with renal function lesion induced by akebia.
Three infants who were fed with Chinese herbal medicines containing akebia trifoliate suffered from acute renal failure, renal glomerular and tubular injury, with symptoms of vomiting, diarrhea, and oliguria. Laboratory tests manifested hyperpotassemia, hyponatremia, elevation of serum creatinine and urea nitrogen, and metabolic acidosis. Renal glomerular lesion was mild, presented with proteinuria and increased serum β(2) microglobin. Renal dysfunction was manifested with alkaline urine, glucosuria, positiveness of urine glucose, ketone and aminoaciduria, and increased urine β(2) microglobin excretion. After symptomatic treatment for 3 to 4 weeks, the renal function of these infants recovered. Proteinuria, aminoaciduria and glucosuria turned negative within 5 to 8 months, 3 months to 1 year, and 9 months to 3 years, respectively. Urine pH decreased to 7.0 after 5.0 - 5.5 years. All cases took citric acid mixtures for 5.5 to 6 years. A 12-years follow-up demonstrated that serum creatinine of 3 cases were within normal range during the first 11 years of life, however recent follow-up showed increased serum creatinine of case 1 and case 2, except for serum creatinine of case 3 remained normal. The estimated glomerular filtration rate (eGFR) of all the 3 cases decreased. Among which, eGFR of case 1 and case 2 were lower than 90 [ml/(min·1.73 m(2))], and decreased 1.1 [ml/(min·1.73 m(2))] and 0.6 [ml/(min·1.73 m(2))] per year during recent six years, respectively. No obvious decrease of eGFR was observed in case 3. Blood gas analysis and urine routine were normal, yet blood and urine β(2) microglobin excretion were still high. Urinary N-acetyl-β-D-glucosaminidase increased again after having returned to normal.
Newborn aristolochic acid nephropathy induced by akebia might induce acute renal failure and renal tubules injury. Renal function could recover after symptomatic treatment in short-term. Nevertheless, glomerular filtration rate presents a slow descending tendency and renal tubules lesion lasted for many years, which requires a long-term follow-up.
总结木通致新生儿马兜铃酸肾病的临床特点及预后。
回顾性分析3例因木通致肾功能损害新生儿的临床表现、治疗及预后资料。
3例服用含三叶木通的中药患儿均出现急性肾衰竭、肾小球及肾小管损伤，有呕吐、腹泻、少尿症状。实验室检查表现为高钾血症、低钠血症、血清肌酐和尿素氮升高及代谢性酸中毒。肾小球病变较轻，表现为蛋白尿和血清β₂微球蛋白升高。肾功能损害表现为碱性尿、糖尿、尿糖、酮体及氨基酸尿阳性，尿β₂微球蛋白排泄增加。经对症治疗3至4周后，患儿肾功能恢复。蛋白尿、氨基酸尿及糖尿分别于5至8个月、3个月至1年、9个月至3年内转阴。5.0至5.5年后尿pH降至7.0。所有病例均服用枸橼酸合剂5.5至6年。12年随访显示，3例患儿在生命的前11年血清肌酐均在正常范围内，但近期随访显示病例1和病例2血清肌酐升高，病例3血清肌酐仍正常。3例患儿的估算肾小球滤过率（eGFR）均下降。其中，病例1和病例2的eGFR低于90 [ml/(min·1.73 m²)]，近6年分别每年下降1.1 [ml/(min·1.73 m²)]和0.6 [ml/(min·1.73 m²)]。病例3未观察到明显的eGFR下降。血气分析和尿常规正常，但血、尿β₂微球蛋白排泄仍高。尿N-乙酰-β-D-氨基葡萄糖苷酶恢复正常后再次升高。
木通致新生儿马兜铃酸肾病可导致急性肾衰竭和肾小管损伤。短期对症治疗后肾功能可恢复。然而，肾小球滤过率呈缓慢下降趋势，肾小管病变持续多年，需要长期随访。
