| <DIV><FONT size=4>（翻译稿）</FONT></DIV>
<DIV><FONT size=4> 非甾体抗炎药（NSAIDs，包括COX-2抑制剂）很少产生肾功能衰竭，但对肾功能受损的患者（特别是老年患者）能增加危害风险。在药物诱导的急性肾功能衰竭中由NSAID引起的占15%。一个病例对照研究估计使用NSAID增加急性肾功能衰竭的风险系数为3.2【95%,Cl 1.8-5.8】。</FONT></DIV>
<DIV><FONT size=4> 我们不断接到使用NSAID患者引起肾功能衰竭的报告。使用NSAIDs药物时应告知可能引起肾功能衰竭或损害，应告知肾功能损害患者引起肾功能衰竭的高危害风险。</FONT></DIV>
<DIV><FONT size=4> 对于肾血流灌注不足的患者，前列腺素产物能够增加维持肾血流量。使用NSAIDs对肾的不良影响主要在于抑制前列腺素介导的血管扩张，从而减少肾血流量。对于低血容量、充血性心力衰竭、肝硬化、多发性骨髓瘤患者使用NSAIDs具有特殊的风险。同样具有风险因素的还有血管紧张素抑制剂、血管紧张素II受体拮抗剂、碳酸酐酶抑制剂。</FONT></DIV>
<DIV><FONT size=4> NSAIDs能对肾脏产生直接的毒性，引起急性肾功能衰竭的主要机制包括急性肾小管坏死和急性间质性肾炎。也有少见的机制如急性乳头坏死和肾血管炎。NSAIDs对肾的不良影响在药物停止后一般是可逆的。</FONT></DIV>
<DIV><FONT size=4> 用药建议：</FONT></DIV>
<DIV><FONT size=4> 肾功能损害或衰竭的患者，特别是老年患者尽可能避免使用NSAIDs。如果NSAIDs必须使用，应考虑采用最低有效剂量在最短的时间内控制症状，并在用药期间监测肾功能。</FONT></DIV>
<DIV><FONT size=4> 使用NSAIDs时应考虑患者其他并存疾病的症状因素，以及并用可能降低肾功能的药物。</FONT></DIV>
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<DIV align=left><B>原文</B></DIV>
<DIV align=left><B>Non-steroidal anti-inflammatory drugs: reminder on renal failure and impairment</B><B></B></DIV>
<DIV align=left>Non-steroidal anti-inflammatory drugs (NSAIDs, including COX-2 inhibitors) may rarely</DIV>
<DIV align=left>precipitate renal failure, and vulnerable (particularly elderly) patients may be at increased</DIV>
<DIV align=left>risk. NSAID use accounts for an estimated 15% of all cases of drug-induced acute renal</DIV>
<DIV align=left>failure.A case-control study estimated an increased relative risk (3·2 [95% CI 1·8–5·8]) of</DIV>
<DIV align=left>acute renal failure in otherwise healthy current users of NSAIDs.</DIV>
<DIV align=left>We continue to receive case reports of renal failure in NSAID users. Prescribing</DIV>
<DIV align=left>information for NSAIDs includes warnings about renal impairment and renal failure, and</DIV>
<DIV align=left>advises that the risk of renal failure is highest in those with existing renal impairment.</DIV>
<DIV align=left>In patients with conditions that cause renal hypoperfusion, prostaglandin production may</DIV>
<DIV align=left>be increased to maintain adequate renal blood flow. The adverse renal effects associated</DIV>
<DIV align=left>with NSAIDs are mainly mediated via inhibition of prostaglandin-induced vasodilation and</DIV>
<DIV align=left>can result in reduced renal blood flow. Patients with conditions such as hypovolaemia,</DIV>
<DIV align=left>congestive heart failure, liver cirrhosis, or multiple myeloma are at particular risk.</DIV>
<DIV align=left>Contributing risk factors include the current administration of medicines such as angiotensin</DIV>
<DIV align=left>converting enzyme (ACE) inhibitors, angiotensin II receptors antagonists, and diuretics.</DIV>
<DIV align=left>NSAIDs may also produce direct toxic effects on the kidney. The main mechanisms for</DIV>
<DIV align=left>acute renal failure include acute tubular necrosis and acute interstitial nephritis. Other rarer</DIV>
<DIV align=left>mechanisms have also been reported, such as acute papillary necrosis and renal vasculitis.</DIV>
<DIV align=left>Adverse renal effects are generally reversible on discontinuation of NSAID treatment.</DIV>
<DIV align=left><B>Advice for healthcare professionals:</B></DIV>
<DIV align=left>? Patients at risk of renal impairment or renal failure (particularly elderly people)</DIV>
<DIV align=left>should avoid NSAIDs if possible. If NSAID treatment is absolutely necessary,</DIV>
<DIV align=left>then the lowest effective dose for the shortest possible duration should be used</DIV>
<DIV align=left>to control symptoms. The renal function of such patients should be carefully</DIV>
<DIV align=left>monitored during NSAID treatment</DIV>
<DIV align=left>? It is important to consider other concomitant disease states, conditions, or</DIV>
<DIV align=left>medicines that may precipitate reduced renal function when prescribing NSAIDs</DIV>
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