Khan Sana, Loi Valentina, Rosner Mitchell H
Division of Nephrology, University of Virginia Health System, Box 800133 HSC, Charlottesville, VA, 22903, USA.
Divisione di Nefrologia e Dialisi, Azienda Ospedaliera Brotzu, Cagliari, Italy.
Drugs Aging. 2017 Oct;34(10):729-741. doi: 10.1007/s40266-017-0484-4.
The incidence of acute kidney injury in the elderly has grown over the past decade. One of the primary drivers is drug-induced nephrotoxicity, which is the result of a combination of the unique susceptibilities to kidney injury and the increased use of medications in the elderly population. Specific drug classes are associated with increased rates of kidney injury including agents that block the renin angiotensin system, antimicrobials, and chemotherapeutic agents. Mechanistically, injury may be due to hemodynamic effects, tubular or glomerular toxicity, and interstitial nephritis. Early recognition of nephrotoxicity is critical, as are preventative steps when applicable. Unfortunately, treatment for established drug-induced kidney injury is limited and supportive care is required. Limiting exposure to nephrotoxic drugs is critical in decreasing the incidence of acute kidney injury in the elderly patient.
在过去十年中，老年人急性肾损伤的发病率有所上升。主要驱动因素之一是药物性肾毒性，这是老年人群对肾损伤的独特易感性与药物使用增加共同作用的结果。特定药物类别与肾损伤发生率增加有关，包括阻断肾素血管紧张素系统的药物、抗菌药物和化疗药物。从机制上讲，损伤可能是由于血流动力学效应、肾小管或肾小球毒性以及间质性肾炎。肾毒性的早期识别至关重要，适用时的预防措施也同样重要。不幸的是，对于已确诊的药物性肾损伤的治疗有限，需要支持性护理。限制接触肾毒性药物对于降低老年患者急性肾损伤的发病率至关重要。
