晚期慢性肾脏病伴危及生命的低钾血症,由未确诊的吉特曼综合征引起。

Artemios G Karagiannidis, Maria-Eleni Alexandrou, George Lioulios, Maria Stangou, Pantelis A Sarafidis, Aikaterini Papagianni
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引用次数: 0

摘要

我们报告一例58岁女性,表现为少尿、疲劳、厌食、便秘、低血容量体征,实验室检查显示严重的低钾血症(1.7 mEq/L)、低钠血症(120 mEq/L)、高血清肌酐(SCr, 6.46 mg/dL)和尿素(352 mg/dL)。患者曾被诊断为慢性肾脏疾病(CKD), 1年前SCr高达2.58 mg/dL,并且在之前的所有实验室检查中显示低钾血症,尽管血压正常,心功能正常,但仍采用保守措施和依普利酮治疗。采用了一套协调的措施来恢复钾缺乏症,恢复低血容量性低钠血症,并支持肾功能(包括4次透析)。此外,仔细的诊断方法发现不适当的高尿钠和钾损失,低钙尿和高肾素血症高醛固酮增多症导致Gitelman综合征和低钾血症相关的慢性小管间质肾病的诊断。重要的是,遵循一套简单的高钾无钠饮食指导,不仅使患者保持高血容量,无症状,电解质正常,而且还恢复了大部分肾功能,并稳定在早期CKD阶段。吉特尔曼综合征是一种罕见的疾病,可以通过简单的措施轻松诊断和治疗;早期诊断对于避免危及生命的并发症是必要的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Advanced chronic kidney disease with life-threatening hypokalemia due to undiagnosed Gitelman syndrome.

Advanced chronic kidney disease with life-threatening hypokalemia due to undiagnosed Gitelman syndrome.

Advanced chronic kidney disease with life-threatening hypokalemia due to undiagnosed Gitelman syndrome.

We report a case of a 58-year-old woman presenting with symptoms of oliguria, fatigue, anorexia, constipation, hypovolemic signs, and laboratory tests showing severe hypokalemia (1.7 mEq/L), hyponatremia (120 mEq/L), high serum creatinine (SCr, 6.46 mg/dL) and urea (352 mg/dL). The patient had previously been diagnosed with chronic kidney disease (CKD), with SCr up to 2.58 mg/dL 1 year prior, and had in all her previous laboratory tests shown hypokalemia, which was treated with conservative measures and eplerenone despite low-normal blood pressure and normal heart function. A set of coordinated measures were applied to restore the potassium deficit, revert hypovolemic hyponatremia, and support renal function (including 4 dialysis sessions). In addition, a careful diagnostic approach revealed inappropriately high urine sodium and potassium losses, hypocalciuria, and hyperreninemic hyperaldosteronism leading to the diagnosis of Gitelman syndrome and hypokalemia-associated chronic tubulointerstitial nephropathy. Importantly, compliance with a simple set of instructions on high potassium and liberal sodium diet enabled the patient not only to remain euvolemic, free of symptoms, and with normal electrolytes, but also to recover a significant part of renal function and stabilize at an earlier CKD stage. Gitelman syndrome is a rare disorder that can be easily diagnosed and treated following simple measures; its early diagnosis is necessary to avoid life-threatening complications.

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