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美沙拉嗪与肾脏病的关联。

The Association of Mesalamine With Kidney Disease.

机构信息

Division of Nephrology, NYU Langone Health, New York, NY; Division of Nephrology, NYU School of Medicine, New York Harbor VA Healthcare System, New York, NY.

Division of Nephrology, NYU Langone Health, New York, NY; Division of Nephrology, NYU School of Medicine, New York Harbor VA Healthcare System, New York, NY.

出版信息

Adv Chronic Kidney Dis. 2020 Jan;27(1):72-76. doi: 10.1053/j.ackd.2019.09.002.

Abstract

The package inserts for products containing 5-aminosalicylic acid, or mesalamine, include the following language regarding the risk of adverse kidney effects: "renal impairment, including minimal change nephropathy, acute and chronic interstitial nephritis, and rarely renal failure, has been reported in patients given products such as mesalamine delayed-release tablets that contain mesalamine or are converted to mesalamine." In this article, we review the data regarding this nephrotoxicity and the recommendations regarding appropriate monitoring. Chronic interstitial nephritis is a rare occurrence in patients treated with these drugs for Crohn disease and ulcerative colitis. Patients often present with asymptomatic reductions in glomerular filtration rate, without accompanying pyuria, skin lesions, or eosinophilia, unlike cases of acute interstitial nephritis. Drug cessation is usually associated with improved kidney function. However, if left undetected, more prolonged exposure to the drug can lead to irreversible kidney failure and end-stage kidney disease. No convincing studies demonstrate efficacy of treatment with corticosteroids. Frequent monitoring of serum creatinine, especially in the first years after initiation of therapy, is recommended.

摘要

含 5-氨基水杨酸(或美沙拉嗪)的产品的说明书中包含以下关于不良反应肾影响的风险信息:“已有报告显示,给予美沙拉嗪肠溶片等含有美沙拉嗪或可转化为美沙拉嗪的产品的患者出现了肾功能损害,包括微小病变肾病、急性和慢性间质性肾炎,极少数情况下还出现了肾衰竭。”本文将对这些肾毒性的数据以及关于适当监测的建议进行综述。在治疗克罗恩病和溃疡性结肠炎的患者中,慢性间质性肾炎的发生率较低。这些患者通常表现为肾小球滤过率无伴随脓尿、皮肤损伤或嗜酸性粒细胞增多的无症状性降低,与急性间质性肾炎不同。停药通常与肾功能改善相关。然而,如果未被发现,更长时间的药物暴露可能导致不可逆转的肾衰竭和终末期肾病。没有令人信服的研究表明皮质类固醇治疗的疗效。建议经常监测血清肌酐,尤其是在开始治疗后的最初几年。

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