A Diabetic Patient with Ketoprofen-Induced Nephrotic Syndrome, Acute Renal Failure and Non-Occlusive Mesenteric Ischemia

一位七十三歲的女性病人，有高血壓及糖尿病病史，近兩年來規則接受降血壓及口服降血糖藥物的治療，但無心臟血管或腎臟的病史，民國八十九年四月，因腹痛發現膽囊結石，而接受了腹腔鏡膽囊切除手術，術後並無任何併發症，其腎功能和常規尿液檢查正常。外科門診追蹤時，醫師給予口服非類固醇性抗發帶藥物(NSAID)- Ketoprofen (Oruvail®)來緩解手術傷口的疼痛，但只服用了三個劑量(共600mg)。在兩週後，她因低血醣(30 mg/dl)引起的神智不清，送至本院急診，發現急性腎臟衰竭(血中肌酸酐為3.9mg/dL)及重度蛋白尿(9.76 gm/day)。兩星期後，腎臟切片檢查發現為微細病變(minimal changedisease)併急性腎小管間質性腎炎(acute tubulointerstitial nephritis)。我們給予類固醇治療數天後，因發生大腸桿菌(Echerichia coli)的尿路敗血症，而停止類固醇的使用。在住院的第31天，她突然發生急性腹痛，經外科剖探查發現上腸繫膜動脈非組塞性缺血性腸道疾病(non-occlusive ischemic bowel disease), 當天因敗血性休克去世。非類固醇性抗發炎藥物在臨床上使用相當普遍，但也造成不少併發症，如：腸骨肝膽疾病，腎臟傷害或皮膚過敏等問題。其中腎臟相關疾患，包括：急性或是慢性腎臟衰竭、腎病症候群併間質性腎炎、水份電解質的異常以及腎臟乳頭壞死等問題。統計上，大約有1~5%的使用者會導致一至兩種相關的腎病變，這與藥物的種類有目。Ketoprofen是propionic acids 類的非類固醇性抗發炎藥物，常被用來作為術後的鎮痛消失，但文獻上報告Ketoprofen所造成如此例的多種併病症，相當地罕見。我們強調老年患者使用非類固醇性抗撥炎藥物的，應該小心謹慎使用，並考慮其相關的潛在疾病，如：高血壓、糖尿病或心臟血管疾病。

關鍵字

微細病變腎病症候群；急性間質性腎炎；急性腎衰竭；缺血性腸道疾病

並列摘要

Non-steroidal anti-inflammatory drugs (NSAIDs) provide an effective treatment for musuloskeletal pain and inflammation, which are the most common complaints the elderly. But variable renal disease entities are proved to be linked with the use of NSAIDs, including fluid retention, electrolyte imbalance, renal hemodynamic change, and acute interstitial nephritis associated with nephritic syndrome (NS) characterized by minimal change disease. The propionic acid derivatives account for about three-fourths of the reported cases. Fenoprofen alone has been incriminated for over one-half of cases, but there are rarely events correlated with the use of Ketoprofen. Infection and thrombosis are the leading cause of morbidity in patients with renal failure and/or NS. But non-occlusive mesenteric ischemia (NOMI) is an uncommon and poorly understood condition characterized by progressive intestinal ischemia leading to infarction, sepsis, and death. All these disease entities entities are very rarely intermingled in one case. We herein report an old diabetic woman who suffered form Ketoprofen-induced NS and acute renal failure. The renal biopsy showed minimal change disease and acute interstitial nephritis. Thereafter, she was afficted with Escherichia coli sepsis, and developed the life-threatening NOMI.

並列關鍵字

non-steroidal anti-inflammatory drugs ； NSAIDs ； Ketoprofen ； minimal change nephritic syndrome ； acute tubulointerstitial nephritis ； acute renal failure ； mesenteric ischemia

國際替代計量

A Diabetic Patient with Ketoprofen-Induced Nephrotic Syndrome, Acute Renal Failure and Non-Occlusive Mesenteric Ischemia

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