药物性肾损害.pptxVIP

药物性肾损害 ;;药物性肾损害?;发病机制;类型;类型;类型;常见有肾损害倾向的药物分类;药物性肾损害的诊断;治疗原则;预防原则;急性过敏性间质性肾炎; The most common current drug causes of AIN include : NSAIDs: including selective COX-2 inhibitors Penicillins and cephalosporins : Methicillin( up to 17% treated for more than 10 days). Rifampin Sulfonamides: trimethoprim-sulfamethoxazole furosemide, bumetanide, thiazide-type diuretics : much less often Ciprofloxacin : a lesser degree Cimetidine (only rare cases have been described with other H-2 blockers such as ranitidine) Allopurinol Proton pump inhibitors: omeprazole and lansoprazole Indinavir 5-aminosalicylates，5-氨基水杨酸 (eg, mesalamine);与剂量无关，若再次使用同类药物症状会再发或加重。 用药后两周发生，也有报道在用药后2-60日内。 全身过敏反应：药物热，药疹，全身淋巴结肿大及关节酸痛，血嗜酸性粒细胞升高，血lgE升高。 无菌性白细胞尿或白细胞管型，嗜酸细胞尿 肾小管功能损害： Fanconi 综合症、肾小管酸中毒、Normal or only mildly increased protein excretion (?= 1 g/day) in most patients 重症可致急性肾衰。;病 理： 肾间质水肿,多数嗜酸性细胞、淋巴-单核细胞浸润,也可有浆细胞和嗜碱性细胞浸润。 病程后期肾间质出现纤维化。 肾小球和血管无异常病理学改变。 免疫荧光检查为阴性，但有时可见IgG及C3沿肾小管基底膜呈线样沉积。;drug-induced AIN HE ?400;治 疗;Plasmapheresis: prednisone and cyclophosphamide治疗的补充 指征：in the rare patient with the interstitial nephritis seems to be induced by deposition of circulating antibodies against the tubular basement membranes IF： IgG 线样沿肾小管基底膜沉积 No proof that this modality is effective in this setting. ;抗菌药物引起的肾损害 ;特 点;Fig : Relationship between duration of days of aminoglycoside administration and percentage of patients developing nephrotoxicity. (JASN 1993,4(1):81-90);易感因素 ;防治措施 ;抗菌药物引起的肾损害 ;特点;抗菌药物引起的肾损害 ;特点;抗菌药物引起的肾损害 ;主要在肾脏排出，尿中含量高，但尿内溶解度低，可在尿路形成结晶 (highly insoluble in urine with a pH of 5.5 or less ;Sulfonamide crystals : needle-shaped crystals, rosettes, and those resembling shocks of wheat;防治措施;抗菌药物引起的肾损害 ;1971 Poole et al. 首次描述。 1971-1995陆续地报道54 例。 1998 De Vriese An S 等案例回顾分析（ Am J Kidney Dis1998; 31: 108–115 ) 1998 Rommania Covic A et al. Rifampicin-induced acute renal failure: a series of 60 patients. Nephrol Dial Transplant1998; 13: 924–929 2001 Wang et