Baraldi A, Ballestri M, Rapanà R, Lucchi L, Borella P, Leonelli M, Furci L, Lusvarghi E
Department of Nephrology, University of Modena, Italy.
Nephrol Dial Transplant. 1998;13 Suppl 7:25-9. doi: 10.1093/ndt/13.suppl_7.25.
One hundred and nine unselected patients with Acute Renal Failure (ARF) of medical aetiology were hospitalized at the Nephrological Unit of Policlinico University Hospital (Modena) during a 30-month period. ARF was considered as a rapid increase of serum creatinine > 2mg/dl over the baseline level or the doubling of pre-existing value in chronic renal failure. Mean age of patients was 67+/-17 years and median age was 72; 64.2% needing dialytic treatment. Four main causes of ARF were identified: 33 patients had reduced renal perfusion by dehydration, hypotension etc.; 20 multifactorial aetiology; 14 biopsy-investigated renal parenchymal diseases and 39 had drug-related acute renal failure (D-ARF). The clinical outcome was significantly worse in elderly patients as regard mortality (P < 0.02), chronic dialytic treatment (P < 0.04) and complete recovery (P < 0.004). The mean age of D-ARF patients was significantly greater than remaining ARF patients (72.6+/-12.8 vs 63.2+/-18.5: P < 0.004. Nonsteroidal antiinflammatory drugs (NSAIDs) and ACE-inhibitors (Ace-i) caused ARF in 24 and 8 patients respectively. Elderly age, vascular disease and monoclonal gammopathy represented the main risk factors and were significantly more frequent in D-ARF patients (P<001, <0.01, <0.04 respectively). Our data confirm the high susceptibility of ageing kidneys to nephrotoxic damage caused by drugs affecting glomerular autoregulation by microvascular mechanisms. Greater attention to renal changes in ageing and an increased dissemination of preventative measures among nephrologists, could reduce the incidence of these serious and potentially lethal diseases.
在30个月的时间里，109例病因未筛选的急性肾衰竭（ARF）患者入住了摩德纳大学综合医院的肾脏病科。ARF被定义为血清肌酐较基线水平快速升高>2mg/dl，或慢性肾衰竭患者肌酐值较之前水平翻倍。患者的平均年龄为67±17岁，中位年龄为72岁；64.2%的患者需要透析治疗。确定了ARF的四个主要病因：33例患者因脱水、低血压等导致肾灌注减少；20例为多因素病因；14例经活检调查为肾实质疾病；39例为药物相关性急性肾衰竭（D-ARF）。在死亡率（P<0.02）、慢性透析治疗（P<0.04）和完全康复（P<0.004）方面，老年患者的临床结局明显更差。D-ARF患者的平均年龄显著高于其余ARF患者（72.6±12.8岁对63.2±18.5岁：P<0.004）。非甾体类抗炎药（NSAIDs）和血管紧张素转换酶抑制剂（Ace-i）分别导致24例和8例患者发生ARF。老年、血管疾病和单克隆丙种球蛋白病是主要危险因素，在D-ARF患者中显著更常见（分别为P<0.01、<0.01、<0.04）。我们的数据证实，衰老的肾脏对通过微血管机制影响肾小球自身调节的药物所致肾毒性损伤高度敏感。更加关注衰老过程中的肾脏变化，并在肾病学家中加强预防措施的传播，可能会降低这些严重且潜在致命疾病的发生率。
