臨牀透析 Vol.18 No.12(2-3-3)


特集名 透析患者における消化管異常
題名 下部消化管異常 (3) 薬剤性腸炎
発刊年月 2002年 11月
著者 牧山 和也 長崎大学医学部附属病院光学医療診療部
【 要旨 】 透析患者は腎機能としての排泄機能,内分泌機能,体液調節機能が障害(低下)され,生体全体の防御と制御機構が正常に作動せず,薬剤による直接的・間接的な消化管粘膜障害を受けやすい状態にある.透析患者に下痢,下血,腹痛,発熱があれば,投与薬剤をチェックし,迅速に大腸前処置なしの大腸内視鏡検査を依頼する必要がある.頻度の高い腸炎は抗生物質起因性腸炎(偽膜性大腸炎,出血性大腸炎),NSAIDs起因性腸炎などである.また,高カリウム血症の治療に陽イオン交換樹脂を使用する場合は,腸閉塞,腸穿孔,腸壊死などの重篤な腸管障害を引き起こすことがあることを忘れてはならない.
Theme Gastrointestinal Complications in Dialysis Patients
Title Drug-associated colitis
Author Kazuya Makiyama Department of Endoscopy, Nagasaki University School of Medicine
[ Summary ] In patients undergoing hemodialysis, excretory functions, endocrine functions, and bodily fluid regulating systems controlling as renal function are impaired. Therefore, drug-related direct/indirect mucosal disorders of the gastrointestinal tract readily occur. When diarrhea, anal bleeding, abdominal pain, and fever are observed in hemodialysis patients, prescribed drugs should be checked, and colonoscopic examination without bowel preparation should be immediately performed. Antibiotic associated colitis (pseudomembranous colitis, hemorrhagic colitis) and NSAIDs-associated colitis are frequently detected. Furthermore, when a cation exchange resin is used to treat hyperpotassemia, it should be considered that this treatment may cause serious injury to the intestinaltract, including ileus, perforation of the large bowel, and necrosis of the large bowel.
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