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非甾体类抗炎药：急性肾损伤(急性肾衰竭)

Authors
Randy Luciano, MD, PhD
Mark A Perazella, MD, FACP
Section Editor
Paul M Palevsky, MD
Deputy Editor
Alice M Sheridan, MD
Translators
李瑛, 主任医师，教授

引言

非甾体类抗炎药(nonsteroidal anti-inflammatory drug, NSAID)是一类用于镇痛及抗炎的药物。NSAID可引起几种不同形式的肾损伤，包括血流动力学介导的急性肾损伤(acute kidney injury, AKI)；电解质和酸碱失衡；急性间质性肾炎(acute interstitial nephritis, AIN)，可能伴有肾病综合征；以及肾乳头坏死(表 1)。

本专题总结血流动力学介导的AKI。NSAID在AIN、慢性肾脏病(chronic kidney disease, CKD)及电解质紊乱中的作用将在别处讨论。 (参见“急性间质性肾炎的临床表现和诊断”和“镇痛药相关的慢性肾脏疾病”和“NSAIDs: Electrolyte complications”)

NSAID的作用机制、治疗作用及与肾脏无关的不良反应也在别处讨论。 (参见“非甾体类抗炎药：作用机制”和“非甾体抗炎药：成人的治疗应用和反应差异”和“非选择性非甾体类抗炎药的不良反应概述”和“非选择性非甾体类抗炎药的心血管不良反应”)

流行病学

所有使用NSAID的患者中约有1%-5%发生肾脏不良事件[1]。由于服用NSAID(每年估计有超过7000万处方和300亿非处方次)的患者很多，也就是说每年有超过250万患者经历肾毒性事件[2]。

AKI可随任何一类传统的、非选择性NSAID或者环氧合酶-2(cyclooxygenase-2, COX-2)特异性NSAID的使用发生[3-8]。例如，一项纳入了121,722例较年长患者的巢式病例对照研究显示，开始使用非选择性NSAID(除外萘普生)、萘普生、罗非昔布和塞来昔布的患者比未暴露该类药物的个体30日内住院风险增加，相对危险度(relative risk, RR)分别为2.3、2.4、2.3和1.5[8]。

           

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Literature review current through: 2017-06 . | This topic last updated: 2017-03-01.
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References
Top
  1. Whelton A. Nephrotoxicity of nonsteroidal anti-inflammatory drugs: physiologic foundations and clinical implications. Am J Med 1999; 106:13S.
  2. Green GA. Understanding NSAIDs: from aspirin to COX-2. Clin Cornerstone 2001; 3:50.
  3. Haragsim L, Dalal R, Bagga H, Bastani B. Ketorolac-induced acute renal failure and hyperkalemia: report of three cases. Am J Kidney Dis 1994; 24:578.
  4. Oates JA, FitzGerald GA, Branch RA, et al. Clinical implications of prostaglandin and thromboxane A2 formation (1). N Engl J Med 1988; 319:689.
  5. Patrono C, Dunn MJ. The clinical significance of inhibition of renal prostaglandin synthesis. Kidney Int 1987; 32:1.
  6. Perazella MA. COX-2 selective inhibitors: analysis of the renal effects. Expert Opin Drug Saf 2002; 1:53.
  7. Perazella MA, Tray K. Selective cyclooxygenase-2 inhibitors: a pattern of nephrotoxicity similar to traditional nonsteroidal anti-inflammatory drugs. Am J Med 2001; 111:64.
  8. Schneider V, Lévesque LE, Zhang B, et al. Association of selective and conventional nonsteroidal antiinflammatory drugs with acute renal failure: A population-based, nested case-control analysis. Am J Epidemiol 2006; 164:881.
  9. Braden GL, O'Shea MH, Mulhern JG, Germain MJ. Acute renal failure and hyperkalaemia associated with cyclooxygenase-2 inhibitors. Nephrol Dial Transplant 2004; 19:1149.
  10. Dunn MJ. Are COX-2 selective inhibitors nephrotoxic? Am J Kidney Dis 2000; 35:976.
  11. Perazella MA, Eras J. Are selective COX-2 inhibitors nephrotoxic? Am J Kidney Dis 2000; 35:937.
  12. Swan SK, Rudy DW, Lasseter KC, et al. Effect of cyclooxygenase-2 inhibition on renal function in elderly persons receiving a low-salt diet. A randomized, controlled trial. Ann Intern Med 2000; 133:1.
  13. Gooch K, Culleton BF, Manns BJ, et al. NSAID use and progression of chronic kidney disease. Am J Med 2007; 120:280.e1.
  14. Wei L, MacDonald TM, Jennings C, et al. Estimated GFR reporting is associated with decreased nonsteroidal anti-inflammatory drug prescribing and increased renal function. Kidney Int 2013; 84:174.
  15. Huerta C, Castellsague J, Varas-Lorenzo C, García Rodríguez LA. Nonsteroidal anti-inflammatory drugs and risk of ARF in the general population. Am J Kidney Dis 2005; 45:531.
  16. Lapi F, Azoulay L, Yin H, et al. Concurrent use of diuretics, angiotensin converting enzyme inhibitors, and angiotensin receptor blockers with non-steroidal anti-inflammatory drugs and risk of acute kidney injury: nested case-control study. BMJ 2013; 346:e8525.
  17. Dubois RN, Abramson SB, Crofford L, et al. Cyclooxygenase in biology and disease. FASEB J 1998; 12:1063.
  18. Bonvalet JP, Pradelles P, Farman N. Segmental synthesis and actions of prostaglandins along the nephron. Am J Physiol 1987; 253:F377.
  19. Chou SY, Dahhan A, Porush JG. Renal actions of endothelin: interaction with prostacyclin. Am J Physiol 1990; 259:F645.
  20. Oliver JA, Pinto J, Sciacca RR, Cannon PJ. Increased renal secretion of norepinephrine and prostaglandin E2 during sodium depletion in the dog. J Clin Invest 1980; 66:748.
  21. Scharschmidt LA, Dunn MJ. Prostaglandin synthesis by rat glomerular mesangial cells in culture. Effects of angiotensin II and arginine vasopressin. J Clin Invest 1983; 71:1756.
  22. Yared A, Kon V, Ichikawa I. Mechanism of preservation of glomerular perfusion and filtration during acute extracellular fluid volume depletion. Importance of intrarenal vasopressin-prostaglandin interaction for protecting kidneys from constrictor action of vasopressin. J Clin Invest 1985; 75:1477.
  23. Clive DM, Stoff JS. Renal syndromes associated with nonsteroidal antiinflammatory drugs. N Engl J Med 1984; 310:563.
  24. Takahashi K, Schreiner GF, Yamashita K, et al. Predominant functional roles for thromboxane A2 and prostaglandin E2 during late nephrotoxic serum glomerulonephritis in the rat. J Clin Invest 1990; 85:1974.
  25. Heyman SN, Brezis M, Epstein FH, et al. Early renal medullary hypoxic injury from radiocontrast and indomethacin. Kidney Int 1991; 40:632.
  26. Perazella MA. Renal vulnerability to drug toxicity. Clin J Am Soc Nephrol 2009; 4:1275.
  27. Weisbord SD, Bruns FJ, Saul MI, Palevsky PM. Provider use of preventive strategies for radiocontrast nephropathy in high-risk patients. Nephron Clin Pract 2004; 96:c56.
  28. Plantinga L, Grubbs V, Sarkar U, et al. Nonsteroidal anti-inflammatory drug use among persons with chronic kidney disease in the United States. Ann Fam Med 2011; 9:423.
  29. Whelton A, Stout RL, Spilman PS, Klassen DK. Renal effects of ibuprofen, piroxicam, and sulindac in patients with asymptomatic renal failure. A prospective, randomized, crossover comparison. Ann Intern Med 1990; 112:568.