アブストラクト
Japanese
| Title | 常用量のバラシクロビル内服後に薬剤性腎障害を発症した小児例 |
|---|---|
| Subtitle | 症例報告 |
| Authors | 長谷川智大1, 奥村保子2, 近藤秀仁2, 松田翔平3, 面田恵3, 西田眞佐志2 |
| Authors (kana) | |
| Organization | 1京都府立医科大学附属病院小児科, 2京都第一赤十字病院小児科, 3中国労災病院薬剤部 |
| Journal | 日本小児腎臓病学会雑誌 |
| Volume | 36 |
| Number | |
| Page | 75-80 |
| Year/Month | 2023 / |
| Article | 報告 |
| Publisher | 日本小児腎臓病学会 |
| Abstract | 「要旨」バラシクロビル(valacyclovir: VACV)は, アシクロビル(acyclovir: ACV)のプロドラッグで, 小児での腎障害の報告は稀である. 症例は14歳女児, 帯状疱疹の診断で前医にてVACV 3,000mg/日を処方された. 内服3日後から嘔吐し, 頸部痛・頭痛・背部痛を訴え, 内服7日目に全身浮腫が出現した. 同日, 前医血液検査で腎障害を認め入院となったが, 乏尿が持続し翌日当院へ転院した. VACVによる薬剤性腎障害を疑い, 血中ACV除去目的に入院5日目, 7日目に血液透析を実施した. 入院10日目の腎生検で, 糸球体・間質に炎症細胞浸潤や結晶形成は認めず, 広範囲に尿細管壊死を呈しており, VACVによる中毒性腎障害を考えた. 後日, 内服7日目の保存血清を用い血中ACV濃度を測定すると, 10.69μg/mL(至適治療濃度:0.8-1.6μg/mL)と異常高値であった. VACVは正常腎機能の小児に対する常用量投与でも腎障害を来しうるため, 患者に処方する際に副作用や飲水量について適切な指導を行い, 予防・早期発見に努める必要がある. |
| Practice | 臨床医学：一般 |
| Keywords | バラシクロビル, 薬剤性腎障害, 急性尿細管壊死 |
English
| Title | Drug-induced acute kidney injury after taking a regular dose of valacyclovir |
|---|---|
| Subtitle | |
| Authors | Tomohiro Hasegawa1, Yasuko Okumura2, Hidehito Kondo2, Shohei Matsuda3, Kei Omoda3, Masashi Nishida2 |
| Authors (kana) | |
| Organization | 1Department of Pediatrics, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 2Department of Pediatrics, Japanese Red Cross Kyoto Daiichi Hospital, 3Department of Pharmacy, Chugoku Rosai Hospital |
| Journal | Japanese Journal of Pediatric Nephrology |
| Volume | 36 |
| Number | |
| Page | 75-80 |
| Year/Month | 2023 / |
| Article | Report |
| Publisher | The Japanese Society for Pediatric Nephrology |
| Abstract | Valacyclovir (VACV) is an acyclovir (ACV) prodrug. We here report a case of a healthy girl who developed acute kidney injury (AKI) after taking a regular dose of VACV. A 14-year-old girl, diagnosed with herpes zoster, was prescribed 3,000mg/day of VACV by her previous doctor. She then complained of headache, neck and back pain, and generalized edema that appeared on the seventh day. After discontinuing the medication, she was admitted to a hospital, where a blood examination indicated an occurrence of renal functional impairment. AKI caused by VACV was suspected, and hemodialysis was performed 5 and 7 days after admission. A renal biopsy performed 10 days after admission revealed extensive vacuolar degeneration and loss of tubular epithelial cells without interstitial mononuclear cell infiltration or crystal formation, suggesting acute tubular necrosis caused by drug-induced toxic injury. Thereafter, the renal function improved, and she was discharged after 21 days of hospitalization. We later requested measurement of ACV blood concentration in a serum sample taken on day 7, which showed an abnormally high ACV level of 10.69μg/mL (appropriate concentration: 0.8-1.6μg/mL). This case indicates that VACV may induce kidney injury even with its regular doses in children with normal renal function. It is necessary to provide appropriate guidance regarding side effects and drinking volume when prescribing VACV to patients and to strive for prevention and early detection. |
| Practice | Clinical medicine |
| Keywords |
- 全文ダウンロード： 従量制、基本料金制の方共に770円(税込) です。
参考文献
- 1) グラクソ・スミスクライン: バルトレックス錠500mgインタビューフォーム第18版. 2021; 1-77.
- 2) 薬剤性腎障害の診療ガイドライン 作成委員会: 薬剤性腎障害診療ガイドライン 2016. 日腎会誌 2016; 58: 477-555.
- 3) 谷澤雅彦: 抗ウイルス薬による尿細管機能障害. 日内会誌 2018; 107: 878-887.
- 4) Goli R, Mukku KK, Devaraju SB, Uppin MS: Acyclovir-induced thrombotic microangiopathy. Indian J Nephrol 2017; 27: 131-132.
- 5) Izzedine H, Launay-Vacher V, Deray G: Antiviral drug-induced nephrotoxicity. Am J Kidney Dis 2005; 45: 804-817.
残りの6件を表示する
- 6) Becker BN, Fall P, Hall C, Milam D, Leonard J, Glick A, Schulman G: Rapidly progressive acute renal failure due to acyclovir: case report and review of the literature. Am J Kidney Dis 1993; 22: 611-615.
- 7) Yildiz C, Ozsurekci Y, Gucer S, Cengiz AB, Topaloglu R: Acute kidney injury due to acyclovir. CEN Case Rep 2013; 2: 38-40.
- 8) Yalcinkaya R, Oz FN, Kaman A, Aydin Teke T, Yasar Durmus S, Celikkaya E, Tanir G: Factors associated with acyclovir nephrotoxicity in children: data from 472 pediatric patients from the last 10 years. Eur J Pediatr 2021; 180: 2521-2527.
- 9) 目黒美結, 渡邊庸平, 田山耕太朗, 宇根岡紗希, 酒井秀行, 上村美季, 渡邉浩司, 大沼良一, 千葉洋夫, 久間木悟: 水痘罹患時にバラシクロビルによると思われる腎機能障害・精神神経症状を呈した一例. 仙台医療セ医誌 2021; 11: 54-57.
- 10) 海老原卓志: バラシクロビルを過量服用した13歳女児. 薬事 2012; 54: 1369.
- 11) 三浦健一郎, 桃井貴裕, 細井洋平, 磯島豪, 小太刀康夫, 高橋和浩, 狩野博嗣, 関根孝司, 五十嵐隆: 腎機能正常なSLE女児に生じたバラシクロビルによる急性腎不全. 日小児腎不全会誌 2010; 30: 152-153.
