Singh Manisha, Shailesh Fnu, Tiwari Upasana, Sharma Shree G, Malik Bilal
Department of Nephrology, University of Arkansas for Medical Sciences , Little Rock, AR , USA .
Ren Fail. 2014 Jun;36(5):804-7. doi: 10.3109/0886022X.2014.890054. Epub 2014 Feb 27.
Phenazopyridine is a urinary analgesic; commonly seen side-effects of this drug include, orange discoloration of urine, methemoglobinemia, yellowish skin discoloration, hepatitis and acute renal failure. Various case reports with phenazopyridine associated acute renal failure secondary to acute tubular necrosis have been reported in the literature. Acute kidney injury in these patients is caused by either direct injury to renal tubular epithelial cells or secondary to pigment induced nephropathy from hemolytic anemia. Hypoxic injury from phenazopyridine-induced methemoglobinemia has been well documented. We report a case of biopsy proven acute interstitial nephritis, associated with therapeutic doses of phenazopyridine without any evidence of methemoglobinemia or other mechanism of renal injury. Clinicians should be aware of the toxicity of this commonly used drug and should look closely for signs of renal insufficiency. Identifying and stopping the offending medication stays as the first step, but recent studies indicate that early steroid administration improves renal recovery, as well as decreasing the risk of progression to chronic kidney disease with fibrosis and consequent permanent renal damage.
非那吡啶是一种尿路镇痛药；该药物常见的副作用包括尿液橙色变色、高铁血红蛋白血症、皮肤发黄、肝炎和急性肾衰竭。文献中已报道了各种非那吡啶相关的急性肾衰竭继发于急性肾小管坏死的病例报告。这些患者的急性肾损伤是由肾小管上皮细胞直接损伤或继发于溶血性贫血引起的色素性肾病所致。非那吡啶诱导的高铁血红蛋白血症引起的缺氧损伤已有充分记录。我们报告一例经活检证实的急性间质性肾炎病例，与治疗剂量的非那吡啶有关，且无高铁血红蛋白血症或其他肾损伤机制的证据。临床医生应意识到这种常用药物的毒性，并应密切留意肾功能不全的迹象。识别并停用致病药物是第一步，但最近的研究表明，早期给予类固醇可改善肾脏恢复，同时降低进展为伴有纤维化和随之而来的永久性肾损伤的慢性肾脏病的风险。
