原发系膜增生性肾小球肾炎合并肾小管酸中毒一例  

Primary mesangial proliferative glomerulonephritis complicated with renal tubular acidosis:a case report

作　　者：陈宗存[1] 蔡小艳 赖舒畅 王秋怡 符茂雄 Chen Zongcun;Cai Xiaoyan;Lai Shuchang;Wang Qiuyi;Fu Maoxiong(Department of Endocrinology,the Second Affiliated Hospital of Hainan Medical University,Haikou 570311,China)

机构地区：[1]海南医学院第二附属医院内分泌科,海口570311

出　　处：《新医学》2022年第9期696-699,共4页Journal of New Medicine

基　　金：海南省自然科学基金(821MS138);海南省卫生健康行业科研项目(21A200041);海南省重点研发计划(ZDYF2021SHFZ080)。

摘　　要：肾小管酸中毒是一种肾小管-间质疾病,是临床上少见的低钾血症的原因之一。目前原发系膜增生性肾小球肾炎合并肾小管酸中毒的相关报道较少。该文报道1例以反复多尿、四肢乏力10年,再发1 d为主诉的34岁男性患者。该患者10年前出现夜尿多、低钾血症,尿蛋白、血白蛋白、估算肾小球滤过率均无异常。5年前出现下肢水肿、尿蛋白阳性,肾活组织检查示原发系膜增生性肾小球肾炎。1 d前再次出现下肢水肿、低钾血症,尿酸化功能试验提示肾小管酸中毒,予补钾、利尿、应用激素等治疗,有效缓解了病情。该例提示原发系膜增生性肾小球肾炎可合并肾小管酸中毒,应注意避免漏诊,在处理肾小管酸中毒的同时及时给予激素治疗有较好的效果。Renal tubular acidosis is an tubule-interstitial disease,which is a rare cause of hypokalemia in clinical practice.At present,primary mesangial proliferative glomerulonephritis complicated with renal tubular acidosis have been rarely reported.In this article,one 34-year old male patient with recurrent polyuria and limb weakness for 10 years,followed by 1 day as chief complaint,was reported.He developed nocturia and hypokalemia 10 years ago,with negative urinary protein and normal blood albumin and estimation of glomerular filtration rate(eGFR).Five years ago,he developed lower limb edema and positive urinary protein.Kidney biopsy showed primary mesangial proliferative glomerulonephritis.The symptoms of lower limb edema and hypokalemia recurred 1 day.Urinary acidification function test indicated renal tubular acidosis.Potassium supplement,diuresis and hormone therapy were given to effectively relieve the condition.The diagnosis and treatment of this case suggest that primary mesangial proliferative glomerulonephritis can be complicated with renal tubular acidosis.Attention should be paid to avoiding missed diagnosis.Interventions for renal tubular acidosis combined with timely hormone therapy yield high clinical efficacy.

关 键 词：原发系膜增生性肾小球肾炎 肾小管酸中毒 低钾血症 水肿 

分 类 号：R692.31[医药卫生—泌尿科学]