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近年来抗感染药物所致急性肾损伤(AKI)有增多趋势。国内资料显示,在药物所致AKI中抗菌药占39.0%～54.0%。引起AKI的抗感染药主要有氨基糖苷类、β-内酰胺类、多肽类和喹诺酮类等。AKI一般发生于患者用药后数日或数周,临床表现为少尿或非少尿型急性肾功能不全,其病理表现为急性肾小管坏死和急性间质性肾炎。发病机制与患者机体免疫反应和药物的直接肾毒性有关。高龄、肾功能不全以及合用其他药物等是AKI的高危因素。一旦发生AKI应立即停药,并给予泼尼松或肾透析治疗。临床医生应重视高危人群的合理用药,避免大剂量或长期用药,加强对患者肾功能监测,以降低AKI的发生率,改善预后。
In recent years, the anti-infective drug-induced acute kidney injury (AKI) has an increasing trend. Domestic data show that in the drug-induced AKI antibacterial drugs accounted for 39.0% ~ 54.0%. Anti-infectives that cause AKI are mainly aminoglycosides, β-lactams, peptides and quinolones. AKI generally occurs in patients with medication a few days or weeks after the clinical manifestations of oliguria or oliguria acute renal insufficiency, the pathological manifestations of acute tubular necrosis and acute interstitial nephritis. The pathogenesis is related to the patient’s immune response and the direct nephrotoxicity of the drug. Elderly, renal insufficiency and other drugs combined with other risk factors for AKI. In the event of AKI should be immediately discontinued, and given prednisone or renal dialysis treatment. Clinicians should pay attention to the rational use of drugs in high-risk groups to avoid high-dose or long-term medication to strengthen the monitoring of renal function in patients with AKI to reduce the incidence and improve prognosis.