药物肾毒性的机制与肾脏损伤防护方法。
The Mechanism of Drug Nephrotoxicity and the Methods for Preventing Kidney Damage.
机构信息
Clinical Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University, 70-111 Szczecin, Poland.
Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, 70-111 Szczecin, Poland.
出版信息
Int J Mol Sci. 2021 Jun 6;22(11):6109. doi: 10.3390/ijms22116109.
Acute kidney injury (AKI) is a global health challenge of vast proportions, as approx. 13.3% of people worldwide are affected annually. The pathophysiology of AKI is very complex, but its main causes are sepsis, ischemia, and nephrotoxicity. Nephrotoxicity is mainly associated with the use of drugs. Drug-induced AKI accounts for 19-26% of all hospitalized cases. Drug-induced nephrotoxicity develops according to one of the three mechanisms: (1) proximal tubular injury and acute tubular necrosis (ATN) (a dose-dependent mechanism), where the cause is related to apical contact with drugs or their metabolites, the transport of drugs and their metabolites from the apical surface, and the secretion of drugs from the basolateral surface into the tubular lumen; (2) tubular obstruction by crystals or casts containing drugs and their metabolites (a dose-dependent mechanism); (3) interstitial nephritis induced by drugs and their metabolites (a dose-independent mechanism). In this article, the mechanisms of the individual types of injury will be described. Specific groups of drugs will be linked to specific injuries. Additionally, the risk factors for the development of AKI and the methods for preventing and/or treating the condition will be discussed.
急性肾损伤 (AKI) 是一个全球性的健康挑战,全球每年约有 13.3%的人受到影响。AKI 的病理生理学非常复杂,但主要原因是败血症、缺血和肾毒性。肾毒性主要与药物的使用有关。药物引起的 AKI 占所有住院病例的 19-26%。药物引起的肾毒性根据以下三种机制之一发展:(1) 近端肾小管损伤和急性肾小管坏死 (ATN)(剂量依赖性机制),其原因与药物或其代谢物的顶端接触、药物和其代谢物的转运有关从顶端表面到管状腔,以及药物从基底外侧表面分泌到管状腔;(2) 由药物和其代谢物形成的晶体或铸型引起的管状阻塞(剂量依赖性机制);(3) 药物及其代谢物引起的间质性肾炎(非剂量依赖性机制)。本文将描述各种损伤的机制。特定类别的药物将与特定的损伤相关联。此外,还将讨论 AKI 发展的危险因素以及预防和/或治疗该疾病的方法。