Analysis Of Clinical And Pathological Features In 236 Cases Drug Associated Acute Kidney Injury

In recent years, the kidney disease incidence caused continues to climb, more and more countries of the world attention. The kidney disease, including variety of performance and the Acute Kidney Injury (Acute Kidney Injury, AKI) is caused by many factors,and induced a series of clinical syndrome of symptoms with the renal function declined rapidly in short-term (hours into weeks) , the glomerular filtration decreased , the normal serum creatinine and the blood urea nitrogen lifts quickly, also the water, electrolyte and acid-base disorders . AKI have the features with onset nasty, condition critical and inside short time can cause patients renal failure. According to the foreign coverage overall mortality rates as high as quantity 26.5% to 45.0%, it is becoming a common clinical department emergency. On this research analyzes diuretic related renal injury, aims to deepen our understanding of the drug related especially diuretics related kidney damage understanding, then reduce its incidence and also improve treatment level.This study is analyzed retrospectively from January 2000 to December 2010 in Rui Jin hospital affiliated to Shanghai Jiao Tong University and diagnosis for drugs to AKI or drugs as sample of patients in AKI. The total number for 236 cases, including the third diuretic related AKI for 139 patients. The basic information, collected patients before the onset of the medical histories, with disease, clinical characteristics, laboratory index, treatment and prognosis is summarized and analyzed by SPSS16.0 packages data processing retrospectively.Results:①Of the 236 cases of drug induced AKI, 146 were males ( 61.9%) and 90 females( 38.1%), among them with diuretics related AKI 139 cases.②60 or older accounted for 33.1%. Total samples 78.4% patients accompanied by a one or more basic diseases, including Chronic Kidney that associated with Chronic Kidney Disease (CKD), Cardiovascular Disease(CVD), high blood pressure (, HT), cardiac insufficiency, anemia, and high uric acid disease were 38.6%, 19.1%, 30.5%, 12.3%, 21.2% and 16.5% respectively.③Drug induced by antibiotics in AKI pathogenic drugs has the largest percentage (31.4%), a diuretic second (16.9%), another Chinese herbal medicine, chemotherapy and contrast agents, etc. Among them the induced by drugs for patients with mixed use is 43.6%.④The main for renal pathology acute tubular necrosis and acute interstitial nephritis primarily, kidney pathological shown: the renal tubular epithelial cell vacuoles degeneration (up to see, 69.6%), the renal tubular basement membrane with/or not with bare fracture, the renal small tube have fall off epithelial cells and the interstitial have different levels of inflammatory cell and different degree of edema.Summing up all the reseach, we reach these conclusions: Drug induced common AKI drug factors include diuretics, antibiotics, chemotherapy, Chinese herbal medicine and contrast agents, etc. Through the statistical, it is shown that Age≥60ys, CVD and heart dysfunction were risk factors for non-recovery from AKI. Diuretics accounted for drugs to patients with AKI factors, ranking second drug factors that up to 16.9%, reminding us to using the diuretics according to patients' individual should adjust to the dosage.The renal pathology shown that the renal tubular injury had relativity with the renal tubular epithelial cell vacuoles degeneration.