Clinical Manifestation and Pathology of Drug-related Acute Renal Failure in Elder Patients

OBJECTIVE:To explore the clinical manifestation,pathological feature and the related drugs of drug-related acute renal failure in elder patients.METHODS:A total of 21 elder patients who underwent renal puncture in China-Japan Friendship Hospital from January 2005 to March 2010 were reviewed with regard to clinical manifestations,renal pathology,treatment,prognosis,and the drugs involved in acute renal failure.RESULTS:Of the 21 cases reviewed,oliguria was noted in 6,anuria was noted in 3 and normal urinary volume was noted in 12;7 had microscopic hematuria yet without gross hematuria;3 had aseptic leukocyturia;24-hour urinary protein level of ≤1.0 g·d-1 was noted in 5,of 1.0-3.5 g·d-1 in 11 and of ≥3.5 g·d-1 in 5 cases.Prior to onset of acute renal failure,9 had normal renal function;3 had mild renal failure,and the renal function in 9 remained unknown.Serum creatinine on admission was(597.9±426.7)μmol·L-1.On admission,ultrasonic examination revealed normal kidney size in 17 cases and enlarged kidney in 4 cases.The pathological findings of renal biopsy showed acute tubular interstitial nephritis in 10 cases,subacute tubulointerstitial nephritis in 3,chronic tubulointerstitial nephropathy in 2,idiopathic membranous nephropathy associated with acute renal tubulointerstitial nephritis in 2,atypical membranous nephropathy associated with acute tubular interstitial nephritis in one case,IgA nephropathy associated with acute tubular interstitial nephritis in 2 and diabetic nephropathy associated with acute tubular interstitial nephritis in 1 case.Scr at discharge was(191.7±106.8)μmol·L-1.No patient died.The acute renal failure were induced by antibiotics,traditional Chinese medicine,NSAIDs,angiotensin converting enzyme inhibitors/angiotensin Ⅱ receptor antagonist,health care products,antituberculosis drugs etc.CONCLUSION:Elder patients had high risk for drug-induced renal failure.Many drugs can induce renal failure.Taking common drugs especially when multiple drugs are used concurrently may lead to renal failure in elder patients.The prognosis for most of the patients with renal failure is well if with early detection and timely diagnosis and treatment;however,for patients with chronic renal disease,the acute renal failure is often severe and which often gives way to chronic renal failure.