Curtis J R
Drugs. 1979 Nov;18(5):377-91. doi: 10.2165/00003495-197918050-00003.
The clinical manifestations of drug-induced renal disease may include all the manifestations attributed to natural or spontaneous renal diseases such as acute renal failure, chronic renal failure, acute nephritic syndrome, renal colic, haematuria, selective tubular defects, obstructive nephropathy, etc. It is therefore vital in any patient with renal disease whatever the clinical manifestations might be, to obtain a meticulous drug and toxin inventory. Withdrawal of the offending drug may result in amelioration or cure of the renal disorder although in the case of severe renal failure it may be necessary to utilise haemodialysis or peritoneal dialysis to tide the patient over the period of acute renal failure. Analgesic nephropathy is an important cause of terminal chronic renal failure and it is therefore vital to make the diagnosis as early as possible. The pathogenesis of some drug-induced renal disorders appears to be immunologically mediated. There are many other pathogenetic mechanisms involved in drug-induced renal disorders and some drugs may under appropriate circumstances be responsible for a variety of different nephrotoxic effects. For example, the sulphonamides have been incriminated in examples of crystalluria, acute interstitial nephritis, acute tubular necrosis, generalised hypersensitivity reactions, polyarteritis nodosa and drug-induced lupus erythematosus.
药物性肾病的临床表现可能包括所有归因于自然或自发性肾病的表现，如急性肾衰竭、慢性肾衰竭、急性肾炎综合征、肾绞痛、血尿、选择性肾小管缺陷、梗阻性肾病等。因此，对于任何患有肾病的患者，无论其临床表现如何，获取一份详尽的药物和毒素清单至关重要。停用致病药物可能会使肾脏疾病得到改善或治愈，不过在严重肾衰竭的情况下，可能有必要进行血液透析或腹膜透析，以使患者度过急性肾衰竭期。镇痛剂肾病是终末期慢性肾衰竭的一个重要原因，因此尽早做出诊断至关重要。一些药物性肾脏疾病的发病机制似乎是由免疫介导的。药物性肾脏疾病还涉及许多其他发病机制，某些药物在适当情况下可能会导致多种不同的肾毒性作用。例如，磺胺类药物已被认定与晶体尿、急性间质性肾炎、急性肾小管坏死、全身性过敏反应、结节性多动脉炎和药物性红斑狼疮有关。
