Gary N E, Buzzeo L, Salaki J, Eisinger R P
Arch Intern Med. 1976 Oct;136(10):1101-4.
Five patients are described in whom only gentamicin sulfate appeared responsible for acute renal failure. Subjects received 1.2 to 2.88 gm over 12 to 18 days. All were over 45 years of age, and premorbid kidney abnormalities may have enhanced susceptibility to toxic effects of the drug. Renal failure appeared 8 to 17 days after beginning gentamicin therapy and was characterized by creatinine clearances 4 to 10 ml/min, urine to plasma creatinine ratios less than 20, urinary sodium concentrations 16 to 60 mEq/liter, proteinuria, and cylindruria. Oliguria was not observed and this feature may impair recognition of kidney damage. Clinical recovery required an average of 42 days and was complete in four of five patients. Gentamicin alone may be nephrotoxic and should be given with particular caution to the elderly and those with even mild kidney abnormalities.
本文描述了5例急性肾衰竭仅由硫酸庆大霉素所致的患者。这些患者在12至18天内接受了1.2至2.88克的药物治疗。所有患者年龄均超过45岁，病前肾脏异常可能增加了对该药物毒性作用的易感性。肾衰竭出现在庆大霉素治疗开始后的8至17天，其特征为肌酐清除率为4至10毫升/分钟、尿肌酐与血肌酐比值小于20、尿钠浓度为16至60毫当量/升、蛋白尿和管型尿。未观察到少尿，这一特征可能会影响对肾损伤的识别。临床恢复平均需要42天，5例患者中有4例完全康复。仅庆大霉素就可能具有肾毒性，对于老年人以及即使有轻度肾脏异常的患者，使用时应格外谨慎。
