他克莫司致肾病综合征患儿急性肾损伤的高危因素分析
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摘要
目的:总结分析他克莫司导致肾病综合征(NS)患儿发生急性肾损伤(AKI)的特点和高危因素。方法:收集我院因他克莫司导致AKI的7例NS患儿的临床资料、联合用药情况和实验室检查数据,分析该群体发生他克莫司相关AKI的特点。结果:除1例患儿外,其余6例患儿谷浓度均<10 ng·ml~(-1)。患儿从开始使用他克莫司到发生AKI的时间中位数为14 d。发生AKI后,4例患儿停用他克莫司,3例减量,此后患儿的肾功能均恢复。长期随访发现,除1例患儿由CKD 3期进展为CKD 5期外,其余6例患儿肾功能均稳定在正常水平。结论:NS患儿发生他克莫司相关AKI的高危因素包括:肾病综合征的未缓解状态、急性胃肠炎、感染和联合用药。存在高危因素的NS患儿使用他克莫司时,应注意监测尿量和肌酐,及时发现AKI情况。
Objective: To investigate the characteristics and risk factors of tacrolimus-induced acute renal injury( AKI) in children with nephrotic syndrome( NS). Methods: The clinical data,combination medications and laboratory data of 7 NS children who suffered from AKI in our hospital were collected retrospectively,and then the characteristics of tacrolimus-induced AKI were analyzed. Results: Except for one patient,the tacrolimus trough levels of the other 6 patients were lower than 10 ng·ml~(-1). Patients developed AKI at a median of 14 days after tacrolimus treatment. All AKI was recovered after tacrolimus reduced in 3 patients and discontinued in 4. After a long-term follow up,the renal function of six patients kept normal,whereas one patient with stage 3 CKD progressed to stage 5 CKD. Conclusion: The unrelieved state of NS,acute gastroenteritis,infection and drug combination were the risk factors of tacrolimus-induced AKI in NS children.When the above situation occurs in children with NS,urine volume and creatinine should be closely monitored in order to timely recognize tacrolimus-induced AKI.
Objective: To investigate the characteristics and risk factors of tacrolimus-induced acute renal injury( AKI) in children with nephrotic syndrome( NS). Methods: The clinical data,combination medications and laboratory data of 7 NS children who suffered from AKI in our hospital were collected retrospectively,and then the characteristics of tacrolimus-induced AKI were analyzed. Results: Except for one patient,the tacrolimus trough levels of the other 6 patients were lower than 10 ng·ml~(-1). Patients developed AKI at a median of 14 days after tacrolimus treatment. All AKI was recovered after tacrolimus reduced in 3 patients and discontinued in 4. After a long-term follow up,the renal function of six patients kept normal,whereas one patient with stage 3 CKD progressed to stage 5 CKD. Conclusion: The unrelieved state of NS,acute gastroenteritis,infection and drug combination were the risk factors of tacrolimus-induced AKI in NS children.When the above situation occurs in children with NS,urine volume and creatinine should be closely monitored in order to timely recognize tacrolimus-induced AKI.
引文
1 Wang W,Xia Y,Mao J,et al.Treatment of tacrolimus or cyclosporine A in children with idiopathic nephrotic syndrome[J].Pediatr Nephrol,2012,27(11):2073-2079
2 Xia T,Zhu S,Wen Y,et al.Risk factors for calcineurin inhibitor nephrotoxicity after renal transplantation:a systematic review and meta-analysis[J].Drug Des Devel Ther,2018,12:417-428
3张宏文,肖慧捷,姚勇.他克莫司治疗小儿肾病综合征致急性肾衰竭3例报告[J].临床儿科杂志,2017,35(6):409-411
4 Sinha R,Marks SD.Tacrolimus toxicity secondary to diarrhoea in nephrotic syndrome[J].Acta Paediatr,2013,102(7):e291-292
5 Naranjo CA,Shear NH,Lanctot KL.Advances in the diagnosis of adverse drug reactions[J].J Clin Pharmacol,1992,32(10):897-904
6中华医学会儿科学分会肾脏病学组.儿童常见肾脏疾病诊治循证指南(一):激素敏感、复发/依赖肾病综合征诊治循证指南(试行)[J].中华儿科杂志,2009,47(3):167-170
7 Kidney Disease Improving Global Outcomes.KDIGO Clinical Practice Guideline for Acute Kidney Injury[J].Kidney International Supplements,2012,2(1):1-138
8中华医学会儿科学分会肾脏学组.儿童激素敏感、复发/依赖肾病综合征诊治循证指南(2016)[J].中华儿科杂志,2017,55(10):729-734
9中华医学会器官移植学分会.中国儿童肝移植临床诊疗指南(2015版)[J].中华移植杂志,2016,10(1):2-11
10 Pandirikkal VB,Jain M,Gulati S.Tacrolimus-induced HUS:an unusual cause of acute renal failure in nephrotic syndrome[J].Pediatr Nephrol,2007,22(2):298-300
11李喆,谢红浪,肾病综合征他克莫司治疗后急性肾损伤的临床特征及预后[D].南京:南京大学硕士学位论文,2015
12 Whiting P,Morden A,Tomlinson LA,et al.What are the risks and benefits of temporarily discontinuing medications to prevent acute kidney injury?A systematic review and metaanalysis[J].BMJ Open,2017,7(4):e012674
2 Xia T,Zhu S,Wen Y,et al.Risk factors for calcineurin inhibitor nephrotoxicity after renal transplantation:a systematic review and meta-analysis[J].Drug Des Devel Ther,2018,12:417-428
3张宏文,肖慧捷,姚勇.他克莫司治疗小儿肾病综合征致急性肾衰竭3例报告[J].临床儿科杂志,2017,35(6):409-411
4 Sinha R,Marks SD.Tacrolimus toxicity secondary to diarrhoea in nephrotic syndrome[J].Acta Paediatr,2013,102(7):e291-292
5 Naranjo CA,Shear NH,Lanctot KL.Advances in the diagnosis of adverse drug reactions[J].J Clin Pharmacol,1992,32(10):897-904
6中华医学会儿科学分会肾脏病学组.儿童常见肾脏疾病诊治循证指南(一):激素敏感、复发/依赖肾病综合征诊治循证指南(试行)[J].中华儿科杂志,2009,47(3):167-170
7 Kidney Disease Improving Global Outcomes.KDIGO Clinical Practice Guideline for Acute Kidney Injury[J].Kidney International Supplements,2012,2(1):1-138
8中华医学会儿科学分会肾脏学组.儿童激素敏感、复发/依赖肾病综合征诊治循证指南(2016)[J].中华儿科杂志,2017,55(10):729-734
9中华医学会器官移植学分会.中国儿童肝移植临床诊疗指南(2015版)[J].中华移植杂志,2016,10(1):2-11
10 Pandirikkal VB,Jain M,Gulati S.Tacrolimus-induced HUS:an unusual cause of acute renal failure in nephrotic syndrome[J].Pediatr Nephrol,2007,22(2):298-300
11李喆,谢红浪,肾病综合征他克莫司治疗后急性肾损伤的临床特征及预后[D].南京:南京大学硕士学位论文,2015
12 Whiting P,Morden A,Tomlinson LA,et al.What are the risks and benefits of temporarily discontinuing medications to prevent acute kidney injury?A systematic review and metaanalysis[J].BMJ Open,2017,7(4):e012674