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目的:探讨1例晚期肾癌患者口服依维莫司片发生急性肾功能不全的原因。方法:对1例口服依维莫司后出现急性肾功能不全的晚期肾癌患者的临床资料进行分析,并观察给予连续性肾脏替代疗法治疗后肾功能的改善情况。结果:患者合并肺部感染,在接受抗感染治疗及口服依维莫司后第4天出现急性肾功能不全。所用抗感染药物对肾功能影响相对较小,但依维莫司有引发急性肾功能不全的可能。患者使用的氟康唑是细胞色素P450(cytochrome P450,CYP450)超家族中CYP3A4的抑制剂,能够抑制依维莫司代谢,从而可能导致急性肾功能不全。结论:同时应用CYP3A4抑制剂可能会导致依维莫司不良反应发生率的增加,而连续性肾脏替代疗法可以治疗依维莫司导致的急性肾功能不全。
Objective: To investigate the causes of acute renal insufficiency in patients with advanced renal cell carcinoma who received oral everolimus. Methods: The clinical data of 1 case of advanced renal cell carcinoma with acute renal insufficiency after oral administration of everolimus were analyzed, and the improvement of renal function after continuous renal replacement therapy was observed. RESULTS: Patients with pulmonary infection developed acute renal failure on day 4 after receiving anti-infective therapy and oral everolimus. Anti-infectives used have a relatively small effect on renal function, but everolimus may trigger acute renal insufficiency. Fluconazole in patients is an inhibitor of CYP3A4 in the cytochrome P450 (CYP450) superfamily, which inhibits the metabolism of everolimus and may lead to acute renal failure. CONCLUSION: Concurrent use of CYP3A4 inhibitors may lead to an increased incidence of everolimus adverse reactions, whereas continuous renal replacement therapy may treat everolimus-induced acute renal insufficiency.