Section of Nephrology, Department of Medicine, Yale University, New Haven.
Section of Nephrology, Department of Medicine, Veterans Affairs Medical Center, West Haven, Connecticut, USA.
Curr Opin Crit Care. 2019 Dec;25(6):550-557. doi: 10.1097/MCC.0000000000000653.
Medications are a relatively common cause of acute kidney injury (AKI), especially in hospitalized patients who are exposed to numerous agents. Drug-related acute tubular/tubulointerstitial injury is the most common cause of AKI associated with these agents. Toxic effects of drugs and their renal handling often lead to various forms of AKI.
The inherent nephrotoxicity of drugs and their transport and metabolism by the kidneys play an important role in the occurrence of acute tubular injury. Apical transport of the aminoglycosides by endocytosis and apical pinocytosis of filtered hydroxyethyl starch into cells lead to acute tubular dysfunction. Transport of tenofovir and cisplatin by organic anion and cation transporters in the basolateral surface of the proximal tubule, respectively, are associated with intracellular drug accumulation and injury. Intratubular deposition of drug crystals with associated AKI occurs with several drugs, in particular the anticancer agent methotrexate. A potentially new mechanism of drug-induced AKI was described with vancomycin - acute vancomycin-related cast nephropathy. Immune-mediated acute tubulointerstitial injury is another cause of drug-induced AKI, as seen with immune checkpoint inhibitors.
Drugs lead to AKI through mechanisms that involve their inherent toxicity as well as their transport and handling by the kidneys.
药物是急性肾损伤（AKI）的一个相对常见的原因，特别是在住院患者中，他们接触到许多药物。与这些药物相关的药物引起的急性肾小管/间质性损伤是与这些药物相关的 AKI 的最常见原因。药物的毒性作用及其肾脏处理常常导致各种形式的 AKI。
药物的固有肾毒性及其在肾脏中的转运和代谢在急性肾小管损伤的发生中起着重要作用。氨基糖苷类药物通过内吞作用的顶端转运和滤过的羟乙基淀粉顶端胞饮作用进入细胞，导致急性肾小管功能障碍。Tenofovir 和顺铂通过有机阴离子和阳离子转运体分别在近端肾小管的基底外侧表面转运，与细胞内药物积累和损伤有关。几种药物，特别是抗癌药物甲氨蝶呤，会导致药物晶体在肾小管内沉积并伴有 AKI。新型药物诱导 AKI 的机制与万古霉素有关——急性万古霉素相关性铸型肾病。免疫介导的急性间质性肾炎是免疫检查点抑制剂引起的另一种药物诱导的 AKI 原因。
药物通过其固有毒性以及肾脏对其的转运和处理导致 AKI。
