Drug-Induced Glomerular Disease: Attention Required!
Drug-Induced Glomerular Disease: Attention Required!
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DOI：
10.2215/cjn.01010115
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发表时间：
2015-07-01
影响因子：
9.8
通讯作者：
Perazella, Mark A.
中科院分区：
文献类型：
--
作者：
Radhakrishnan, Jai;Perazella, Mark A.
药物和毒素经常与各种类型的急性肾脏疾病和慢性肾脏病的发展有关。虽然药物是引起肾小管间质损害的一个广为人知的原因，但药物相关的肾小球损害并没有得到很好的认识，但仍然很重要。接触药物后发生的肾小球损伤可由涉及系膜细胞、内皮细胞或内脏上皮细胞(足细胞)的直接细胞损伤引起。例子包括与吸烟相关的结节状肾小球硬化，以及由多种药物引起的血栓性微血管病变引起的内皮损伤。各种药物也描述了足细胞损伤与微小的改变或FSGS损害的发展。肾小球疾病也可能与药物诱导的免疫调节过程有关。通过不同的途径，药物可以促进许多抗体的形成，这些抗体最终可能会影响肾小球。例子包括狼疮样肾脏病变和ANCA相关的少免疫性血管炎。及早认识到这些情况是至关重要的，因为在许多患者中，停用违规药物后，肾脏参数会有所改善。
Drugs and toxins frequently are associated with the development of various types of acute kidney disease and CKD. Although medications are a widely known cause of tubulointerstitial damage, drug-related glomerular injury is not well appreciated but nonetheless, important. Glomerular damage that occurs after exposure to medications can be caused by direct cellular injury involving the mesangial, endothelial, or visceral epithelial cells (podocytes). Examples include nodular glomerulosclerosis associated with smoking and endothelial injury with thrombotic microangiopathy from a number of medications. Podocyte injury with the development of a minimal change or FSGS lesion has also been described with various medications. Glomerulopathies may also be associated with drug-induced immune-mediated processes. Through various pathways, drugs may promote the formation of a number of antibodies, which may, ultimately, affect the glomerulus. Examples include lupus-like renal lesions and ANCA-related pauci-immune vasculitis. It is critical to recognize these conditions early, because in many patients, there is improvement in renal parameters on stopping the offending medication.