The clinicopathological features of drug-induced acute kidney injury-a single-center retrospective analysis.
The clinicopathological features of drug-induced acute kidney injury-a single-center retrospective analysis.
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DOI：
10.21037/atm-20-3826
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发表时间：
2021-03
影响因子：
--
通讯作者：
Chen J
中科院分区：
文献类型：
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作者：
Cui Y;Yang Y;Lei W;Lang X;Chen J
本研究旨在分析药物性急性肾损伤（阿基）的药物谱和临床病理特征随近期用药习惯改变的变化。回顾性分析2012年1月至2016年10月浙江大学医学院附属第一医院诊断为药物性阿基的患者特征。2012年1月至2016年10月，909名患者被诊断为阿基。其中，228例被诊断为药物相关阿基的患者参与了本研究，其中51例接受了肾活检，74例接受了抗菌和抗病毒药物治疗，63例接受了非甾体抗炎药（NSAID）治疗，17例接受了中草药治疗。阿基最常与抗生素和抗病毒药物相关，包括头孢菌素、阿昔洛韦、阿奇霉素、克林霉素和左氧氟沙星。肾活检诊断为过敏性间质性肾炎12例，间质性肾炎19例，肾小管上皮细胞损伤8例，微小病变型肾病2例，伊加肾病2例，轻度系膜增生伴肾小球硬化2例。平均随访时间为437天，范围为3至2，756天。228例患者中，165例完全康复，4例部分康复，8例未康复，51例出院后失访。药物性阿基的三个主要贡献者是抗菌药物、NSAID和中草药。三个不同药物诱导的阿基组的年龄分布存在显著差异。过敏性间质性肾炎、间质性肾炎和肾小管上皮细胞损伤是药物性阿基的主要病理表现。新的预测诺模图在药物诱导的阿基患者中实现了2周内预测恢复的良好性能。
This study aimed to analyze changes to the drug spectrum and clinicopathological features of drug-induced acute kidney injury (AKI) with recent medication habits changes. A retrospective analysis of the characteristics of patients diagnosed with drug-induced AKI from January 2012 to October 2016 period at the First Affiliated Hospital of the Medical College of Zhejiang University was conducted. Between January 2012 and October 2016, 909 patients were diagnosed with AKI. Of these, 228 were diagnosed with drug-related AKI were engaged in this study, including 51 who underwent renal biopsies, 74 treated with antibacterial and antiviral drugs, and 63 who received nonsteroidal anti-inflammatory drugs (NSAIDs), and 17 who were treated with Chinese herbal medicine. AKI was most frequently associated with antibiotics and antiviral drugs, including cephalosporins, acyclovir, azithromycin, clindamycin, and levofloxacin. In those who underwent renal biopsy, 12 patients were diagnosed with allergic interstitial nephritis, 19 with interstitial nephritis, 8 with renal tubular epithelial cell injury, 2 with minimal change nephropathy, 2 with IgA nephropathy, and 2 with mild mesangial hyperplasia with glomerulosclerosis. The mean follow-up time was 437 days, ranging from 3 to 2,756 days. Among 228 patients, 165 recovered completely, 4 recovered partially, 8 did not recover, and 51 were lost to follow-up after discharge. The three main contributors to drug-induced AKI were antimicrobial agents, NSAIDs, and Chinese herbal medicines. The age distribution of the three different drug-induced AKI groups was significantly different. Allergic interstitial nephritis, interstitial nephritis, and tubular epithelial cell injury were the main pathological manifestations of drug-induced AKI. The novel predictive nomogram achieved a good performance of prediction recovery within 2 weeks in drug-induced AKI patients.