Höffler D, Koeppe P
Medizinische Klinik III, Städtische Kliniken, Darmstadt, Fed. Rep. of Germany.
Arzneimittelforschung. 1993 Nov;43(11):1233-8.
Twelve studies on the pharmacokinetics of various antibiotics (11 beta-lactams, 1 quinolone) in renal failure were re-examined on a meta-level. It was found that besides the expected (and obvious) decrease of renal clearance in impaired renal function, the nonrenal clearance (CLNR) also decreased: in terminal renal insufficiency, CLNR was approximately only half the value found in healthy subjects. A possible explanation for this could be the uremic intoxication and the resulting disturbance of the metabolic processes. Though the absolute value decreases, nonrenal clearance in renal failure is a relevant part of the total elimination: the ratio nonrenal to total elimination doubled and was even more. Furthermore, the amount of substances eliminated per nephron was found to increase. The ratio "renal clearance/glomerular filtration rate", the tubular load, increased as well. This might have positive effects (exceptionally high concentrations of antibiotics at important sites in kidney infections) but also negative consequences (higher tubular toxicity depending on the concentration).
对12项关于各种抗生素（11种β-内酰胺类、1种喹诺酮类）在肾衰竭患者中药代动力学的研究进行了荟萃分析。结果发现，除了肾功能受损时预期（且明显）的肾清除率下降外，非肾清除率（CLNR）也降低：在终末期肾功能不全时，CLNR约仅为健康受试者的一半。对此的一个可能解释是尿毒症中毒以及由此导致的代谢过程紊乱。尽管绝对值下降，但肾衰竭时的非肾清除率是总清除的一个重要组成部分：非肾清除率与总清除率的比值翻倍甚至更高。此外，发现每个肾单位清除的物质数量增加。“肾清除率/肾小球滤过率”这一比值，即肾小管负荷也增加。这可能有积极作用（在肾脏感染的重要部位抗生素浓度异常高），但也有负面后果（取决于浓度的更高的肾小管毒性）。
