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急性磷酸盐肾病

Authors
Glen S Markowitz, MD
Mark A Perazella, MD, FACP
Section Editor
Paul M Palevsky, MD
Deputy Editor
Alice M Sheridan, MD
Translators
齐华林, 副主任医师

引言

急性磷酸盐肾病是在使用含有口服磷酸钠(oral sodium phosphate, OSP)的肠道催泻药后出现的一种肾脏损伤形式，并且在使用含磷酸钠的灌肠剂后已报道过该病[1,2]。OSP在以前是非处方药物，商品名为“Fleet Phospho-soda”(C.B.Fleet Inc.)。Fleet公司不再销售OSP，但仍可以买到非处方的OSP非专利药物。通过处方也可获得OSP片剂(Visicol, OsmoPrep；Salix Pharmaceuticals)。片剂和液体形式的OSP都是高渗性轻泻药，通过将水引入胃肠道而发挥作用。

尽管OSP长期被用作轻泻药，但在1990年，它被开始用于结肠镜检查中的催泻药[3]。由于OSP的需要量更少(使得患者依从性更佳)且结肠清洁效果更好，所以常使用OSP，而非以聚乙二醇(polyethylene glycol, PEG)为基础的标准灌洗液[4-6]。

然而，已有多个病例通过活检中的组织学特征而被确诊为OSP引起的急性肾损伤(acute kidney injury, AKI)[7-11]。这种临床病理学疾病被称为急性磷酸盐肾病。

在2006年，鉴于多项已发表的报告，美国食品药品监督管理局(Food and Drug Administration, FDA)发布了一则有关使用OSP可能引起AKI的警告[12]。这个警告也被纳入到美国结直肠外科医师协会(American Society of Colon & Rectal Surgeons, ASCRS)、美国胃肠内镜学会(American Society of Gastrointestinal Endoscopy, ASGE)和美国胃肠内镜外科医师协会(Society of American Gastrointestinal & Endoscopic Surgeons, SAGES)有关肠道准备的共识文件中[13]。2008年12月，美国FDA要求生产商在Visicol和OsmoPrep(这两种药物仍可通过处方获得)的标签中增加黑框警示[14]。同时，在FDA作出该推荐后，Fleet公司自愿将含OSP的非处方制剂撤离市场，但正如上文所述，目前仍可买到OSP非专利药物。2014年，FDA再次发出警告，24小时内使用超过1剂的OSP来治疗便秘可引起“罕见但严重的肾脏和心脏损害，甚至死亡”[15]。

本专题将总结急性磷酸盐肾病的临床特征。在肿瘤溶解综合征中，尤其是通过静脉给予含碳酸氢盐的液体来碱化尿液时，也已报道过磷酸盐负荷增加相关的AKI。肿瘤溶解综合征将在别处讨论。 (参见“肿瘤溶解综合征：定义、发病机制、临床表现、病因及危险因素”)

                

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Literature review current through: 2017-06 . | This topic last updated: 2017-03-08.
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