Early Markers of Nephrotoxicity in Patients With Metal-on-metal Hip Arthroplasty
Early Markers of Nephrotoxicity in Patients With Metal-on-metal Hip Arthroplasty
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DOI：
10.1007/s11999-010-1682-0
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发表时间：
2011-06-01
影响因子：
4.2
通讯作者：
McMinn, Derek J. W.
中科院分区：
文献类型：
--
作者：
Corradi, Massimo;Daniel, Joseph;McMinn, Derek J. W.
关节成形术设备释放的金属离子在尿液中大部分被清除，导致肾脏组织中暴露在高水平。经过验证的肾脏损害早期标志物通常用于监测重金属行业的工人，在这些行业中，肾脏风险可以量化。目前尚不清楚金属对金属髋关节患者的离子水平是否足以导致肾脏损害。与未接触金属的受试者相比，使用金属对金属(MOM)支架10年的患者是否会导致早期肾脏标志物的升高？我们回顾了10年前接受MOM髋关节重建术的31名患者。采集全血样本用于金属离子分析，血清用于肌酐测定，尿样用于定时金属离子输出量和肾脏标志物。以30例年龄、性别匹配、无金属接触、无肾脏疾病或糖尿病的受试者作为肾脏标志物的对照。MOM组的平均血肌酐水平为1.1 mg/dL(四分位数范围为1.0-1.2 mg/dL)，中位数内生肌酐清除量为79.2毫升/分。在这一队列中，肾损害标志物高于参考范围的患者数量与对照组相当。肾脏标记物与金属水平均无相关性。在植入MOM 10年后，该队列中肾脏标记物没有升高，这是令人放心的。然而，我们认为需要通过进一步的更长期、大规模的对照试验来监测这种关节置换引起的低强度(但长期)微量元素暴露，以排除潜在的肾毒性。水平III，回顾性比较研究。有关证据级别的完整描述，请参阅作者指南。
Metal ions released from arthroplasty devices are largely cleared in urine, leading to high exposure in renal tissues. Validated early markers of renal damage are routinely used to monitor workers in heavy metal industries, and renal risk can be quantified in these industries. It is unclear if the ion levels in patients with metal-on-metal hips are sufficient to cause renal damage.Does metal-on-metal (MOM) bearing use over a 10-year period lead to elevation of early renal markers compared with the levels expected in subjects with no metal exposure?We retrospectively reviewed 31 patients who underwent MOM hip resurfacings 10 years earlier. Whole blood specimens were collected for metal ion analysis, serum for creatinine estimation, and urine for timed metal ion output and renal markers. The renal marker levels of 30 age- and gender-matched subjects with no metal exposure and no known renal problems or diabetes mellitus were used as controls for renal markers.Median serum creatinine level in the MOM group was 1.1 mg/dL (interquartile range, 1.0-1.2 mg/dL) and median creatinine clearance was 79.2 mL/min. In this cohort, the number of patients with markers of renal damage above the reference range was comparable to the controls. None of the renal markers were associated with metal levels.The absence of elevation of renal markers in this cohort 10 years after MOM bearing implantation is reassuring. However, we believe surveillance through further longer-term, large-scale controlled trials are needed to monitor this arthroplasty-induced low-intensity (but long-term) trace element exposure to rule out potential nephrotoxicity.Level III, retrospective comparative study. See Guidelines for Authors for a complete description of levels of evidence.