Ghane Shahrbaf Fatemeh, Assadi Farahnak
Department of Pediatrics, Section of Nephrology, Mashhad University of Medical Sciences, Mashhad, Iran.
Department of Pediatrics, Section of Nephrology, Rush University Medical Center, Chicago, Illinois, USA.
J Renal Inj Prev. 2015 Sep 1;4(3):57-60. doi: 10.12861/jrip.2015.12. eCollection 2015.
Drug-induced nephrotoxicity are more common among infants and young children and in certain clinical situations such as underlying renal dysfunction and cardiovascular disease. Drugs can cause acute renal injury, intrarenal obstruction, interstitial nephritis, nephrotic syndrome, and acid-base and fluid electrolytes disorders. Certain drugs can cause alteration in intraglomerular hemodynamics, inflammatory changes in renal tubular cells, leading to acute kidney injury (AKI), tubulointerstitial disease and renal scarring. Drug-induced nephrotoxicity tends to occur more frequently in patients with intravascular volume depletion, diabetes, congestive heart failure, chronic kidney disease, and sepsis. Therefore, early detection of drugs adverse effects is important to prevent progression to end-stage renal disease. Preventive measures requires knowledge of mechanisms of drug-induced nephrotoxicity, understanding patients and drug-related risk factors coupled with therapeutic intervention by correcting risk factors, assessing baseline renal function before initiation of therapy, adjusting the drug dosage and avoiding use of nephrotoxic drug combinations.
药物性肾毒性在婴幼儿以及某些临床情况下更为常见，如存在潜在肾功能不全和心血管疾病时。药物可导致急性肾损伤、肾内梗阻、间质性肾炎、肾病综合征以及酸碱和液体电解质紊乱。某些药物可引起肾小球内血流动力学改变、肾小管细胞炎症变化，导致急性肾损伤（AKI）、肾小管间质性疾病和肾瘢痕形成。药物性肾毒性在血管内容量减少、糖尿病、充血性心力衰竭、慢性肾脏病和脓毒症患者中往往更频繁发生。因此，早期发现药物不良反应对于预防进展至终末期肾病很重要。预防措施需要了解药物性肾毒性的机制，认识患者和药物相关风险因素，并通过纠正风险因素进行治疗干预，在开始治疗前评估基线肾功能，调整药物剂量并避免使用肾毒性药物组合。
