中国药物警戒 ›› 2025, Vol. 22 ›› Issue (2): 221-223.
DOI: 10.19803/j.1672-8629.20240156

• 安全与合理用药 • 上一篇    下一篇

依洛尤单抗注射液致肾移植后慢性肾脏病患者急性肾损伤1例分析

王松岚1, 孙颖1, 陈爱群1, 纪立伟2,*   

  1. 1北京医院肾内科,国家老年医学中心,中国医学科学院老年医学研究院,北京 100730;
    2北京医院药学部,国家老年医学中心,中国医学科学院老年医学研究院,药物临床风险与个体化应用评价北京市重点实验室,北京 100730
  • 收稿日期:2024-03-06 出版日期:2025-02-17 发布日期:2025-02-17
  • 通讯作者: *纪立伟,女,硕士,主任药师,临床药学与药物警戒。E-mail：jlw1228@sina.com
  • 作者简介:王松岚,女,硕士,副主任医师,肾内科。
  • 基金资助:
    首都卫生发展科研专项项目（首发2022-1-4052）

One Case of Acute Kidney Injury Induced by Evolocumab Injection in a Patient with Chronic Kidney Disease after Renal Transplantation

WANG Songlan1, SUN Ying1, CHEN Aiqun1, JI Liwei2,*   

  1. 1Department of Nephrology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China;
    2Department of Pharmacy, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Key Laboratory of Drug Clinical Risk and Personalized Medication Evaluation, Beijing 100730, China
  • Received:2024-03-06 Online:2025-02-17 Published:2025-02-17

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摘要： 目的 为预防临床应用依洛尤单抗注射夜致急性肾损伤提供参考。方法 分析1例肾移植后慢性肾脏病3期患者应用依洛尤单抗注射液致急性肾损伤诊疗经过及因果关系,结合文献相关内容讨论发病机制。结果 患者因冠心病、血脂异常接受阿托伐他汀钙片和依折麦布片调脂治疗。因血脂水平未达标,更换为依洛尤单抗注射液140 mg皮下注射,4个月内共应用 5 次。用药后血肌酐逐渐缓慢升高,由用药前144 μmol·L-1升高到218 μmol·L-1,排除其他肾损伤因素后考虑与依洛尤单抗有关。停用该药54 d后血肌酐逐渐下降至156 μmol·L-1,继续随访肾功能稳定。结论 首次报道应用依洛尤单抗可能导致急性肾损伤,临床该药用于高危患者需监测血肌酐水平,出现血肌酐明显升高应及时停药,确保患者用药安全。

关键词: 依洛尤单抗, 注射液, 急性肾损伤, 肾移植后慢性肾脏病, 蛋白转化酶枯草溶菌素 9抑制剂, 药品不良反应

Abstract: Objective To provide evidence for clinical use of evolocumab injection and to prevent acute kidney damage. Methods The diagnosis and treatment process and cause of acute kidney injury induced by evolozumab injection in a patient with chronic kidney disease after kidney transplantation were analyzed. Based on literature review, the pathogenesis was discussed. Results A 58-year-old male patient who had received allogeneic renal transplantation was treated with atorvastatin calcium tablets and ezetimibe tablets for coronary heart disease and dyslipidemia. Due to poor efficacy, these tablets were replaced by evolocumab 140 mg for subcutaneous injection, which was used 5 times in 4 months. The serum creatinine increased gradually from 144 μmol·L-1 before medication to 218 μmol·L-1. After other factors for kidney injury were excluded, the symptom was considered to be related to evolocumab injection, which was then discontinued. Serum creatinine gradually decreased to 156 μmol·L-1 54 days after withdrawal. Renal function was stable during follow-up. Conclusion Evolocumab injection may possibly cause acute kidney injury, so clinicians need to monitor the level of serum creatinine and discontinue the drug when necessary.

Key words: Evolocumab, Injection, Acute Kidney Injury, Chronic Kidney Disease after Renal Transplantation, Preprotein Converting Enzyme Subtilisin Kexin 9 Inhibitor(PCSK9i), Adverse Drug Reaction

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