tubulotoxic lesions

Introduction

Introduction The tubular lesion is caused by nephropathy due to poisoning of immunosuppressive drug and anticancer drug. It refers to glomeruli, tubules and interstitial caused by the application of immunosuppressants and anticancer drugs. Quality lesions and bladder damage, the kidney is the main organ of drugs, poison metabolism and excretion in the body. During its metabolism and excretion, it can cause toxic effects on the kidney in various ways, causing kidney damage and toxic nephropathy. ).

Cause

Cause

(1) Causes of the disease

The kidney is the main organ for drug, toxic metabolism and excretion in the body. During its metabolism and excretion, it can cause toxic effects on the kidney in various ways, causing kidney damage and toxic nephropathy. In recent years, due to the widespread use or abuse of various drugs in clinical practice, the incidence of acute and chronic renal failure caused by drugs is increasing, especially in the elderly and patients with existing kidney diseases. The causes of kidney damage caused by immunosuppressive drugs and anticancer drugs are:

1. Direct toxic effects on the kidney: normal human kidney blood flow accounts for 25% of the whole body, and the weight of the kidney is only 0.4% to 0.5% of the body weight, so the kidney is the most abundant organ in the body, a large number of drugs and Metabolites flow to the kidneys with the blood, which is easy to cause direct toxicity to the kidneys.

2. Extensive contact of drugs with glomeruli and renal tubules: The drug has an increased chance of toxic damage through extensive contact with the surface of glomerular capillary endothelial cells and renal tubular epithelial cells.

3. Kidney oxygen demand: Kidney tissue has high metabolic activity, requires adequate blood flow and oxygen supply, and consumes a large amount of oxygen. When ischemia and hypoxia occur, the sensitivity of the kidney to drugs increases, which is apt to produce toxic effects.

4. Renal tubular countercurrent multiplication mechanism (convection concentrating effect): Due to the reabsorption of water by the renal tubules, the drug is concentrated in the renal tubule cavity, the drug concentration in the small lumen is increased, and the drug is accumulated and poisoned. Kidney disease, especially tubular lesions.

(two) pathogenesis

There may be the following aspects: direct action on renal blood vessels, reducing renal blood flow; preventing or inhibiting the production and release of prostacyclin stimulating factor, facilitating platelet aggregation and deposition, causing vascular endothelial damage; directly injuring renal tubules, and Other drug-induced toxic tubular lesions are similar; activation of calcium channels leads to increased calcium-dependent nephrotoxicity.

Examine

an examination

Related inspection

Renal CT examination

According to the history of renal toxic contact, patients with suspected nephropathy should be treated with blood routine, urine routine, kidney B ultrasound, renal pelvic venography, renal scan, renal biopsy (electron microscopy report), urine test, renal function test.

Diagnosis

Differential diagnosis

To be differentiated from acute tubular necrosis. Acute tubular mecrosis (ATN) is the most common type of acute renal failure, accounting for 75% to 80%. It is a clinical syndrome that occurs due to renal ischemia and/or nephrotoxicity caused by various causes of renal function and progressive decline. Mainly manifested as progressive azotemia caused by a significant decrease in glomerular filtration rate, as well as imbalance of water, electrolyte and acid-base balance caused by renal tubular reabsorption and excretion.

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