Larsson R, Bodemar G, Kågedal B, Walan A
Acta Med Scand. 1980;208(1-2):27-31. doi: 10.1111/j.0954-6820.1980.tb01145.x.
Cimetidine has been administered during 7 days to 28 patients with different degrees of renal failure. Thirteen of these patients had a further week's treatment at least one month later. The daily dose of cimetidine was reduced in relation to pretrial values of creatinine clearance. There was a clear rise in serum creatinine all through the trial (22.3 +/- 2.6% at day 7) (p < 0.001). Maximal decreases in creatinine clearance occurred on day 2 (21.8 +/- 2.2%) and day 3 (23 +/- 2.0%) (p < 0.001), but were still present on days 6 (16.4 +/- 2.9%) and 7 (17.3 +/- 2.8%) (p < 0.001). There was a small rise in serum uric acid all through the trial (p < 0.05). Three days after finished treatment there were no significant differences in serum creatinine, creatinine clearance and serum uric acid when compared to pretrial values. The pattern of changes in serum creatinine and creatinine clearance was the same in both mild and severe renal failure. Glomerular filtration rate determined by |52Cr¿ EDTA clearance before, on day 3 of treatment and 3 days after treatment did not show any differences. No change was seen in serum beta 2-microglobulin during the trial. The decrease in creatinine clearance during treatment with cimetidine is probably not caused by a reduction of glomerular filtration rate, but could be explained by competition by cimetidine for tubular secretion of creatinine. Treatment with cimetidine of patients with renal failure may invalidate measurements of serum creatinine and creatinine clearance as standard routine tests for glomerular filtration rate.
对28例不同程度肾衰竭患者给予西咪替丁治疗7天。其中13例患者至少在1个月后又接受了1周的治疗。西咪替丁的日剂量根据肌酐清除率的治疗前值进行了调整。在整个试验过程中血清肌酐明显升高（第7天升高22.3±2.6%）（p<0.001）。肌酐清除率的最大降幅出现在第2天（21.8±2.2%）和第3天（23±2.0%）（p<0.001），但在第6天（16.4±2.9%）和第7天（17.3±2.8%）仍存在下降（p<0.001）。在整个试验过程中血清尿酸略有升高（p<0.05）。治疗结束3天后，与治疗前值相比，血清肌酐、肌酐清除率和血清尿酸无显著差异。轻度和重度肾衰竭患者血清肌酐和肌酐清除率的变化模式相同。治疗前、治疗第3天和治疗后3天通过|52Cr-EDTA清除率测定的肾小球滤过率无差异。试验期间血清β2-微球蛋白未见变化。西咪替丁治疗期间肌酐清除率的降低可能不是由肾小球滤过率降低引起的，而是可以用西咪替丁竞争肌酐的肾小管分泌来解释。肾衰竭患者使用西咪替丁治疗可能会使作为肾小球滤过率标准常规检测的血清肌酐和肌酐清除率测量结果无效。
