In recent years, the incidence of pharmacogenic acute renal failure has increased year by year due to the abuse of out-of-hospital or in-hospital drugs as an important medical source of disease. Currently, the most common drugs for kidney damage are various antibiotics, accounting for 39-54%, followed by antipyretic and analgesic drugs, diuretics and dehydration machines, and herbal medicines are more common. In recent years, domestic and foreign literature has reported that some other drugs commonly used in the internal medicine system can also lead to acute renal failure, which deserves attention.
The pathogenesis of drug-induced pharmacogenic acute renal failure is mainly.
1, drug-induced changes in renal hemodynamics, resulting in reduced renal perfusion.
2, drug-induced tubular necrosis caused by the toxic effect of drugs on renal tubules.
3, drug-induced immune response leading to acute interstitial nephritis.
4, drug crystalline deposition leading to tubular lumen obstruction.
5, drug-induced immune-mediated glomerulonephritis.
Therefore, pharmacogenic acute renal failure can be classified into pre-renal, glomerular, renal vascular, tubulointerstitial or post-renal mechanisms.
I. Cardiovascular drugs
1. antiplatelet agents, clopidogrel, which can cause acute interstitial nephritis or hemolytic-uremic syndrome.
2. anticoagulant, warfarin, which can cause acute interstitial nephritis.
3. calcium antagonists, which can lead to reduced renal perfusion when applied in high doses.
4, lipid-regulating drugs, fibrates mechanism is unknown, statins can cause rhabdomyolysis leading to myoglobin-related acute renal failure.
Second, antiviral drugs
1, acyclovir, mainly by renal excretion, the original form accounted for 62-91% by the renal tubular secretion, low urinary solubility, high dose application is easy to intrarenal obstruction, foreign reports 12-48% of cases of intravenous use can occur in acute renal failure, often occurring 24-48 hours after the drug, there can be nausea, vomiting, back pain and even oliguria.
2, interferon, causing kidney damage to glomerular lesions are the main.
Third, the digestive system
1, H2 blockers, cimetidine, ranitidine, famotidine can cause acute interstitial nephritis, mostly occurring within 2 weeks, independent of the dose; cimetidine can also inhibit renal tubular excretion of creatinine and cause an increase in blood creatinine.
2, proton pump inhibitors, omeprazole, lansoprazole, pantoprazole, rabeprazole can cause acute interstitial nephritis, the prognosis is good after stopping the drug.
The current level of medical treatment for most diseases can only be symptomatic, inappropriate use of drugs harmful to the human body, the rational use of drugs related to the success or failure of health care reform, related to your health and mine!