HYPOMAGNESEMIA AND RENAL MAGNESIUM WASTING IN PATIENTS TREATED WITH CISPLATIN
HYPOMAGNESEMIA AND RENAL MAGNESIUM WASTING IN PATIENTS TREATED WITH CISPLATIN
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DOI：
10.1016/s0272-6386(86)80020-8
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发表时间：
1986-09-01
影响因子：
13.2
通讯作者：
ADELSTEIN, DJ
中科院分区：
文献类型：
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作者：
LAM, M;ADELSTEIN, DJ
顺铂(顺铂II)是一种用于治疗上皮性肿瘤的化疗药物，已知会导致低镁血症和肾脏镁消耗。为了进一步确定多剂量顺铂对血清镁水平和肾脏镁处理的影响，我们前瞻性地研究了28名患者，他们总共接受了82剂顺铂。所有患者都出现了与剂量相关的低镁血症(r=.66，P<；.001，n=101)；个别患者达到的最低血清镁水平在0.3至1.7mgldL之间。有19例患者有肾镁浪费的记录，尽管血清镁水平为≤1.5 mg/dL，但尿镁排泄分数从2.9%到22.3%不等。在顺铂用药后2-4天进行的47次尿沉渣检查中，有47次发现了肾小管损伤的证据(肾小管上皮细胞或肾小管上皮细胞管型)。没有明确的证据表明顺铂导致了肾脏对镁以外的电解质的处理缺陷；事实上，28名患者中有16人表现出渴望的肾脏重吸收一种或多种其他电解质，尽管镁的浪费很大。我们的结论是，顺铂改变了肾小管对镁的处理，导致剂量相关的低镁血症显著延长。
Cisplatin (cis-diamminedichloroplatinum II), a chemotherapeutic agent used against epithelial neoplasms, is known to cause hypomagnesemia and renal magnesium wasting. In order to further characterize the effect of multiple doses of this drug upon serum magnesium levels and renal magnesium handling, we prospectively studied 28 patients who received a total of 82 doses of cisplatin. All patients developed hypomagnesemia that was dose-related (r= .66,P< .001, n = 101); the lowest serum magnesium level reached in individual patients ranged from 0.3 to 1.7 mgldL. Renal magnesium wasting was documented in 19 patients, with urinary fractional excretion of magnesium ranging from 2.9% to 22.3% despite serum magnesium levels of ≤ 1.5 mg/dL. Evidence of renal tubular injury (renal tubular epithelial cells or tubular cell casts) was detected in 47 of 47 urine sediment examinations performed two to four days after cisplatin administration. There was no clear evidence that cisplatin caused defects in renal handling of electrolytes other than magnesium; in fact, 16 of the 28 patients demonstrated avid renal reabsorption of one or more other electrolytes despite significant magnesium wasting. We conclude that cisplatin alters renal tubular handling of magnesium, resulting in significant prolonged dose-related hypomagnesemia.