第475例——肾小管酸中毒,肾衰竭,贫血,乳酸酸中毒  

The 475th case:renal tubular acidosis,renal failure,anemia,and lactic acidosis

作　　者：陈罡[1] 吴东[2] 李明喜[1] Chen Gang;Wu Dong;Li Mingxi(Department of Nephrology,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Gastroenterology,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院肾内科,100730 [2]中国医学科学院,北京协和医学院,北京协和医院消化内科,100730

出　　处：《中华内科杂志》2020年第2期165-168,共4页Chinese Journal of Internal Medicine

摘　　要：患者女性,47岁。因恶心、呕吐半年,发现肾功能异常(血肌酐255μmol/L)3 d就诊,入院检查发现近端肾小管酸中毒合并贫血,排除自身免疫病、药物、毒物、单克隆免疫球蛋白病等继发因素,肾脏穿刺活检组织病理提示急性间质性肾炎,予泼尼松50 mg/d;碳酸氢钠4 g,3次/d;促红细胞生成素3000 U,2次/周;氯化钾缓释片500 mg,3次/d;碳酸钙500 mg,3次/d;骨化三醇0.5μg,1次/d。患者血肌酐恢复至90μmol/L,但随诊期间患者恶心呕吐加重,再次检查发现合并乳酸酸中毒(乳酸14.1 mmol/L)。骨髓穿刺提示非霍奇金淋巴瘤,予CHOP方案化疗,期间乳酸酸中毒逐步好转(乳酸由14.5 mmol/L降至3.1 mmol/L),半个月后发生重症耶氏肺孢子菌肺炎,最终放弃治疗出院。A 47-year-old female patient presented nausea and vomiting for half a year and elevated serum creatinine for 3 days.Proximal renal tubular acidosis(RTA)complicated with anemiawas confirmed after admission.Secondary factors,such as autoimmune disease,drugs,poison,monoclonal gammopathy,were excluded.Renal biopsy revealed acute interstitial nephritis.The patient was administrated with daily prednisone 50 mg,sodium bicarbonate 4 g,3 times per day,erythropoietin 3000 U,2 times per week,combined with potassium,calcium,and calcitriol tablets.Serum creatinine reduced to 90μmol/L.However nausea and vomiting deteriorated with lactic acidosis.Bone marrow biopsy indicated the diagnosis of non-Hodgkin lymphoma,therefore the patient was treated with chemotherapy.Although metabolic acidosis improved gradually after chemotherapy,severe pneumocystis carinii pneumonia developed two weeks later.The patient refused further treatment and was discharged.

关 键 词：酸中毒 肾小管性 肾功能衰竭 范可尼综合征 酸中毒 乳酸性 淋巴瘤 

分 类 号：R692[医药卫生—泌尿科学]