Acute kidney injury associated with trimethoprim/sulfamethoxazole
Acute kidney injury associated with trimethoprim/sulfamethoxazole
复制标题
DOI：
10.1093/jac/dks030
复制
发表时间：
2012-05-01
影响因子：
5.2
通讯作者：
Musher, Daniel M.
中科院分区：
文献类型：
--
作者：
Fraser, Traci Nicole;Avellaneda, Andres A.;Musher, Daniel M.
甲氧苄啶/磺胺甲恶唑可有效治疗社区获得性软组织感染和尿路感染，这两种感染均发生在有肾功能损害危险因素的患者中。我们系统地研究了甲氧苄氨嘧啶/磺胺甲恶唑对中年退伍军人肾脏的不良影响。我们回顾了所有患者的完整电子记录，这些患者在3年期间接受了epsilon 6天的甲氧苄氨嘧啶/磺胺甲恶唑治疗，并且基线和随访测定血清肌酐和血尿素氮（BUN）。在573名符合纳入标准的患者中，64名（11.2）患者血清肌酐和BUN均升高，符合急性肾损伤（AKI）的预定标准：33名（5.8）患者判断AKI可能是由于甲氧苄氨嘧啶/磺胺甲恶唑所致；28例（4.9例），可能是甲氧苄氨嘧啶/磺胺甲恶唑所致；3(0.52)，与甲氧苄啶/磺胺甲恶唑无关。另外5例患者（0.9）仅血清肌酐升高。在几乎所有可能由甲氧苄氨嘧啶/磺胺甲恶唑引起的病例中，AKI在停药后迅速消退，但有1例患者需要透析。37例尿检患者中仅有2例出现脓尿；未见嗜酸性粒细胞尿症。在一个多变量模型中，高血压和糖尿病患者发生肾功能不全的风险增加，特别是如果这些情况被认为控制不良。在住院治疗至少6天的中年男性患者中，甲氧苄啶/磺胺甲恶唑治疗的AKI比先前报道的要常见得多。绝大多数病例的病因是内源性肾脏损害，而不是间质性肾炎或肌酐清除的竞争，在单变量分析中没有发现剂量和持续时间的影响。如果停止治疗，损伤是短暂的。
Trimethoprim/sulfamethoxazole effectively treats community-acquired soft tissue infections and urinary tract infections, both of which occur in patients with risk factors for renal impairment. We systematically studied the adverse renal effects of trimethoprim/sulfamethoxazole in a middle-aged veteran population.We reviewed complete electronic records for all patients who, during a 3 year period, had received epsilon 6 days of treatment with trimethoprim/sulfamethoxazole and for whom a baseline and follow-up determination of serum creatinine and blood urea nitrogen (BUN) were available.Of 573 patients who met inclusion criteria, 64 (11.2) had increases in both serum creatinine and BUN that met predetermined criteria for acute kidney injury (AKI): in 33 (5.8), AKI was judged likely due to trimethoprim/sulfamethoxazole; in 28 (4.9), possibly due to trimethoprim/sulfamethoxazole; and in 3 (0.52), unrelated to trimethoprim/sulfamethoxazole. Five additional patients (0.9) had elevations only in serum creatinine. In nearly all cases likely due to trimethoprim/sulfamethoxazole, AKI resolved promptly after discontinuation of therapy, but one patient required dialysis. Pyuria appeared in only 2 of 37 patients who had urinalyses; eosinophiluria was not observed. In a multivariate model, patients with hypertension and diabetes mellitus had increased risk for renal insufficiency, especially if these conditions were considered poorly controlled.In a middle-aged male inpatient population treated for a minimum of 6 days, AKI is much more common with trimethoprim/sulfamethoxazole therapy than previously reported. Intrinsic renal impairment rather than interstitial nephritis or competition for creatinine clearance appears responsible for the great majority of cases, and neither an effect of dose nor duration was detected in a univariate analysis. Impairment is transient if therapy is discontinued.