Respiratory paralysis in Sjogren syndrome with normal renal function

We report a 28-year-old woman who presented with quadriparesis and respiratory failure, and had severe hypokalaemia and distal renal tubular acidosis. She recovered completely on potassium and alkali supplementation. Biopsy and scintigraphy of the minor salivary glands confirmed the presence of Sjogren syndrome. A 6-month course of prednisolone did not correct the distal renal tubular acidosis.     

Total body potassium depletion and renal tubular dysfunction following carbenoxolone therapy

A patient with hypokalaemia-associated renal tubular damage following carbenoxolone therapy is described. The hypokalaemia was reflected by a low level for total body potassium (TBK) and investigations confirmed renal tubular dysfunction. Hypokalaemic nephropathy may be secondary to intracellular potassium depletion rather than the hypokalaemia itself.     

谷胱甘肽对顺铂所致肾小管上皮细胞毒性的保护作用

目的 探讨谷胱甘肽（GSH）对顺铂所致不同性别大鼠肾小管上皮细胞毒性的影响。方法 从不同性别的大鼠分离的肾小管上皮细胞接种于96孔培养液，培养24h后加入一系列浓度的顺铂，或在加入顺铂前的16和4h，分别加入GSH合成抑制剂BSO和GSH合成前体物半胱氨酸，再培养24h后用MTT方法检测细胞存活率。结果：顺铂对雌雄大鼠肾小管上皮细胞具有形状相似的剂量－反应关系曲线，半数抑制浓度（IC50）分别为0.178mmol/L和0.182mmol/L；BSO能使2组IC50均2降低为0.001mmol/L，可使剂量－反应曲线左移，而半胱氨酸则可使2组IC50均升高，均大于5mmol/L，使剂量－反应曲线下沉。结论 顺铂对雌雄大鼠肾小管上皮细胞同样具有明显的毒性；BSO和半胱氨酸可分别增强和降低顺铂的毒性，间接证明细胞内GSH对顺铂所致大鼠肾小管上皮细胞毒性有保护作用，且与性别无前。     

A clinical approach to common electrolyte problems: 3. Hypophosphatemia

Hypophosphatemia is a common disorder caused by decreased intake, increased loss or transcellular shift of phosphorus. Symptoms of severe hypophosphatemia include reversible depression of myocardial function, acute respiratory failure, coma, rhabdomyolysis, osteomalacia, renal tubular acidosis and hemolysis. This paper discusses common clinical disorders associated with hypophosphatemia and presents an approach to diagnosis and treatment.     

阴离子间隙在儿科疾患中的分析与应用

阴离子间隙(AG)是近年来应用于临床的评价酸碱紊乱的重要指标。本文应用微电脑分析了170例儿科患儿的 AG 及其与血清电解质之关系,结果显示:39.9%的患儿 AG 在正常范围,平均 AG 为11.07mmol/L,52.1%呈 AG 增高,平均 AG 为20.99-mmol/LAG 降低占8%,平均 AG 为4.11mmol/L;AG 正常者,AG 与钠呈正相关,与碳酸氢盐呈负相关;AG 增高时,与钠、钾、氯、碳酸氢盐均呈负相关;AG 降低者中有69.2%出现高血氯。本文结果还表明,代谢性酸中毒者有63.8%AG 增高,AG 无增高者主要是由于高氯、低钠所致;AG 增高者中有70.6%为临床诊断有代谢性酸中毒。并提出 AG 增高可作为代谢性酸中毒的诊断指标,尤其是当 AG>25mmol/L 时,诊断更为可靠。本文还分析了婴儿腹泻、支肺炎等儿科常见病患儿的 AG 及血清电解质情况。     

Lysozyme and hypokalaemia

Serum potassium, lysozyme and urinary lysozyme measurements were made in 98 patients with tuberculosis, 18 with sarcoidosis and 30 with acute myeloid leukaemia. Serum K concentration fell below 3·5 mmol/l in 17 of the 30 leukaemic patients and only 7 of these had raised serum lysozyme concentrations. None of the patients in the tuberculosis-sarcoidosis group with lysozymaemia or lysozymuria developed hypokalaemia. This study suggests that raised lysozyme concentrations are not causally related to hypokalaemia.     

Progressive hypokalaemia in elderly patients taking three thiazide potassium-sparing diuretic combinations for thirty-six months

Three different thiazide potassium-sparing diuretic combinations were given to elderly patients for heart failure. Eighty patients received their allocated combinations for 3 years and had 6-monthly measurements of plasma potassium. A further 84 were recruited for study but 29 died within 6 months and 55 had to be withdrawn from the trial. The triamterene-containing preparation was discontinued most frequently (6/44) because of hypokalaemia (plasma potassium less than 3.0 mmol/l); amiloride (5/44) and spironolactone (1/47). The median fall in plasma potassium over 3 years in those patients not withdrawn because of hypokalaemia was similar in each case (P greater than 0.05) and possibly failed to reach significance because of the withdrawal rate (9%). The trend was for a greater fall in those patients taking triamterene. The spironolactone-containing preparation may be the least unsatisfactory of the three.     

Hypokalaemia and hyperkalaemia

Disturbances in potassium homoeostasis presenting as low or high serum potassium are common, especially among hospitalised patients. Given the fact that untreated hypokalaemia or hyperkalaemia is associated with high morbidity and mortality, it is critical to recognise and treat these disorders promptly. In this article, normal potassium homoeostasis is reviewed initially and then a pathophysiological approach to work-up and management of hypokalaemia and hyperkalaemia is presented. Recent advances with respect to the role of kidney in handling of the potassium, the regulation of renal ion transporters in hypokalaemia, and treatment of hypokalaemia and hyperkalaemia will be discussed.


     

丙酮酸乙酯对肾脏缺血再灌注小鼠及化学低氧下HK-2细胞的保护作用

目的观察丙酮酸乙酯(EP)对肾脏缺血再灌注BABL/c小鼠及化学性低氧下人近端肾小管上皮细胞株HK-2的保护作用。方法建立肾脏缺血再灌注小鼠模型及应用antimycine A(AA)及脱氧葡糖(DOG)在体外培养的HK-2细胞中模拟缺氧状态,应用不同浓度EP在不同时间点干预。通过血清学及组织病理检查以及四甲基偶氮唑盐比色法、乳酸脱氢酶(LDH)活性分析等,观察EP对缺血再灌注小鼠及化学性低氧下HK-2细胞的保护作用。结果EP不同时间的干预能降低尿素氮和肌酐,同时减轻组织病理改变；低浓度EP能促进低氧下HK-2细胞的增殖,减少LDH释放。结论EP能有效防治小鼠肾脏缺血再灌注损伤；低浓度EP能通过促进细胞增殖保护化学性低氧导致的HK-2细胞损伤。其作用机制有待进一步研究。     

体内转染核因子-κB诱捕物可减轻急性缺血性肾损伤

目的　探讨核因子 κB (NF κB)诱捕物寡聚核苷酸 (ODN)对急性缺血性肾损伤的保护作用。方法　采用肾动脉夹闭法制备大鼠缺血性急性肾衰竭 (iARF)模型 ,应用鱼精蛋白 脂质体法经肾动脉转染NF κB诱捕物ODN进行治疗。 2 4只大鼠被分成 4组 :假手术组 ,急性肾衰竭组 (iARF组 ) ,NF κB诱捕物ODN治疗组 (NF κB组 )和错配物ODN处理组。应用生化和组织学指标检测肾脏损伤的程度 ;凝胶电泳迟滞分析检测肾组织NF κB/DNA结合活性 ;免疫组化和RT PCR技术分别检测单核 巨噬细胞浸润 (M/MΦ)和单核细胞趋化蛋白 1(MCP 1)的表达。结果　经鱼精蛋白 脂质体法转染NF κB诱捕物ODN 12h后 ,ODN主要分布在肾小管上皮。与假手术组比较 ,iARF组血清Cr、BUN水平分别增加 10倍和 5倍 ( 2 5 6 μmol/L± 84 μmol/Lvs 2 5 μmol/L± 5 μmol/L和 4 3 4 7μmol/L± 13 4 8μmol/Lvs8 4 5mmol/L± 1 0 7mmol/L ,Ps<0 0 1) ;肾小管损伤评分明显升高 ( 3 6 3± 0 15vs 0 0 0± 0 0 0 ,P <0 0 1) ;NF κB /DNA结合活性明显增加 [中位数 (M) :1 75vs0 15 ,P <0 0 5 ];M/MΦ以及MCP 1的表达水平明显上升。与iARF组比较 ,NF κB组经诱捕物ODN治疗后 ,血清Cr水平下降 70 % ( 79μmol/L± 2 1μmol/Lvs 2 5 6 μmol/L± 84 5     

Failed peritoneal dialysis in a dehydrated nephrotic child,in acute renal failure: a case report

A case of failed peritoneal dialysis in a 5-year-old male nephrotic who developed acute renal failure following severe P. falciparum malaria infection is presented. Peritoneal dialysis (PD) failure was sequel to undetected severe dehydration which occurred during the diuretic phase of the acute renal failure. Pre-dialysis plasma potassium, bicabonate, urea and creatinine concentrations were 6.0mmol/L, 13mmol/L, 28mmol/L and 900mmol/L respectively, after about 22 hours of PD, the plasma K+, HCO-3 Ur and Cr were 5.7mmol/L, 15mmol/L, 32mmol/L and 1,090mml/L respectively. The peritoneal dialysate Ur concentration (3.5mmol and peritoneal Ur clearance (1.85ml/min/1.73m2) were grossly inadequate. There was also, intradialysis hyperglycaemia (12mmol/L owing to massive absorption of peritoneal dialysate solution which contains high concentration of glucose. Hyperglycaemia was corrected with 0.25 units/kg/dose of soluble insulin intravenously, he had two doses. Owing to similarity of clinical and biochemical features of dehydration and ARF, all efforts must be made to exclude dehydration before embarking on PD in patients with renal failure. Failure to exclude dehydration, led to PD failure in this patient.     

Incomplete distal renal tubular acidosis with nephrocalcinosis

We report the case of a female patient with incomplete distal renal tubular acidosis with nephrocalcinosis. She was admitted to the hospital because of acute pyelonephritis. Imaging studies showed dual medullary nephrocalcinosis. Subsequent evaluations revealed hypokalemia, hypocalcemia, hypercalciuria, and hypocitraturia with normal acid-base status. A modified tubular acidification test with NH4Cl confirmed a defect of urine acidification, which is compatible with incomplete distal tubular acidosis. We treated our patient with potassium citrate, which corrects hypokalemia and prevents further deposition of calcium salts.     

白细胞介素-10对肾小管上皮细胞转分化的影响

目的研究白细胞介素-10（interleukin-10,IL-10）对高糖诱导的人近端肾小管上皮细胞（HK-2细胞）转分化（epithelial to mesenchymal transition,EMT）的影响。方法将培养的HK-2细胞通过完全随机设计分为5组：①对照组：5．5mmol／L的D-葡萄糖组;②高糖组：30mmol／L的D-葡萄糖组;③30mmol／L的D-葡萄糖＋1ng／ml IL-10组;④30mmol／L的D-葡萄糖＋5ng／ml IL-10组;⑤30mmol/L的D-葡萄糖＋25ng／ml IL-10组。培养48h后,RT-PCR法检测各组细胞CTGF mRNA的表达;免疫细胞化学法和Western blot法检测各组细胞α-SMA的表达;ELISA法检测各组细胞FN的分泌。结果在高糖中加入1、5、25ng／ml的IL-10作用后,与高糖组相比HK-2细胞CTGF、α-SMA和FN表达减少,且均有统计学差异（P〈0．05）。结论IL—10可以抑制高糖环境下的。肾小管EMT。     

Life-threatening hypokalaemia associated with ibuprofen-induced renal tubular acidosis

Renal tubular acidosis is an underreported complication of ibuprofen misuse, and can result in life-threatening hypokalaemia. We describe four patients who presented with profound hypokalaemia and muscle weakness associated with excessive ibuprofen ingestion. Ibuprofen cessation and supportive management resulted in complete biochemical resolution within a few days. These cases remind practitioners about potential complications of unmonitored use of over-the-counter analgesics, including those with potential for misuse due to their codeine content.     

不同浓度尿酸对体外培养肾小管上皮细胞氧化应激及凋亡的影响

目的：探讨不同浓度尿酸对肾小管上皮细胞氧化应激及凋亡的影响。方法将人近曲小管上皮细胞株(HKC?8)随机分为对照组和尿酸A组、尿酸B组和尿酸C组,每组15例,对照组加入培养液,尿酸A组、尿酸B组和尿酸C组分别加入0.1 mmol/L、0.4 mmol/L和0.8 mmol/L尿酸,培养24 h,光泽精化学发光法检测各组肾小管上皮细胞内超氧阴离子生成量,紫外分光光度法检测还原型辅酶ⅡNADPH酶蛋白水平,脱氧核糖核苷酸末端转移酶介导的缺口末端标记法(TUNEL）检测肾小管上皮细胞凋亡率。结果尿酸A组、B组和C组肾小管上皮细胞内超氧阴离子生成量和NADPH酶蛋白水平高于对照组,且呈剂量依赖,差异均有统计学意义(P<0.05);尿酸A组、B组和C组肾小管上皮细胞凋亡率高于对照组,亦呈剂量依赖,差异均有统计学意义(P<0.05);尿酸A组、B组和C组肾小管上皮细胞凋亡率分别为(73.4±11.7)%、(322.6±23.2)%、(432.7±34.1)%,均高于对照组的(16.9±1.2)%,差异均有统计学意义(P<0.05)。结论尿酸干预能够影响肾小管上皮细胞内超氧阴离子生成量、NADPH酶蛋白水平和肾小管上皮细胞凋亡率,尿酸浓度越高,超氧阴离子生成量、NADPH酶蛋白水平和肾小管上皮细胞凋亡率越高。     

表现为严重低钙血症、周期性麻痹的Gitelman 氏综合征

患者,女,63岁,因反复乏力,双下肢瘫痪,双手搐搦50 年,加重2 年入院。查体:P80/min,BP120/70mmHg,BMI23.0kg/m2,WHR0.84,焦虑,四肢肌力正常,膝反射、踝反射轻度减弱。无阳性家族史,无服用利尿剂及泻药史。实验室检查示低血钾(2.77～3.17mmol/L),低血镁(0.31～0.35mmol/L),低血钙(1.79～1.99mmol/L),和低尿钙(0.12～1.10mmol/24h)。血浆肾素活性升高,血浆醛固酮水平正常,PTH水平正常。尿钙及尿肌酐比低(5.17～23.57×10-3mg/mgCr),血气分析显示代谢性碱中毒。在该患者进行的速尿或双氢克尿噻的清除率试验中,使用速尿后其尿量及氯离子的清除率增加,远端肾小管氯离子的重吸收分数降低;而使用双氢克尿噻后以上变化均不明显,提示缺陷位于远曲小管而不是亨利氏襻的厚壁升之段。因此,Gitelman氏综合征(Gitelman'ssyndrome,GS)诊断明确。给予消炎痛50mg,tid治疗3d后,复查患者的血钾水平开始上升,但血镁及血钙水平无明显改善,加用氨苯蝶啶50mg,tid治疗,4d后发现血钾及血钙水平恢复正常,血镁从0.35mmol/L升到0.52mmol/L出院;院外随访18个月,复查血钾、血钙及血镁水平完全恢复正常。GS可伴有严重低钙血症、周期性麻痹,肾脏清除率试验在临床上可帮助诊断,消炎痛及氨苯蝶啶联合应用治疗有效。     

Myocardial damage due to hypokalaemia and hypophosphataemia

A case of severe hypokalaemia with stupor, skeletal muscle and heart muscle damage is reported. An initial infusion of glucose-insulin and potassium (GIK) produced a temporary clinical improvement with reduction of creatine kinase (CKMB) and elevation of serum K+. On the 4th day of treatment, neuromuscular and cardiovascular deterioration occurred accompanied by a further rise of CKMB. This deterioration was coincident with a serum phosphate of 0.26 mmol/l. The impaired left ventricular (LV) function was measured using echocardiography and detecting the ejection fraction (EF). GIK was stopped and a potassium phosphate infusion commenced. As the phosphate and potassium deficiencies were corrected, the neuromuscular and cardiac abnormalities resolved, CKMB fell to normal and LVEF rose from 40% to 72%. We suggest that additional cardiac damage due to hypophosphataemia may have occurred in this patient, who already had cardiac impairment as a result of profound hypokalaemia. Possible mechanisms are discussed.     

Record linkage study of hypokalaemia in hospitalized patients.

Retrospective analysis of biochemical data from 58,167 hospital inpatients revealed that 21% developed hypokalaemia during hospitalization-in 5.2% the serum potassium was less than 3.0 mmol/l. Subsequent evaluation showed a positive correlation between hypokalaemia and both female sex and hospital mortality. Patients with leukaemia and lymphoid tumours, especially when receiving antibiotic or cytotoxic therapy, and patients with gastro-intestinal malignancy were amongst those most frequently experiencing hypokalaemia. There was no significant association with cardiovascular disease. Drug and intravenous fluid administration accounted for the hypokalaemia in 56% of patients. While drug-related hypokalaemia was most commonly seen with diuretics, it was also apparent following use of steroids, insulin and haematinics.     

肺心病三重酸碱失衡诊断的临床探讨

本文对12例肺心病呼酸型三重酸碱失衡的患者进行研究,结果提示当疑诊有呼酸合并代酸时,血乳酸含量是一项重要指标,通常应高于5mmol/L,当呼酸合并代酸并疑诊有代碱时应测定血浆“潜在”HCO-_3含量,通常大于AB预计代偿值或高于45mmol/L,当呼酸合并代碱并疑诊有代酸时,除血浆AG值应大于20mmol/L才有诊断代酸的价值外,强调测定血乳酸含量。此外AG值在17mmol/L～20mmol/L范围时,不能完全除外有无代酸,应结合血乳酸含量综合诊断。     

A study of two diuretic/potassium combinations in heart failure

The effect of potassium supplements was studied in 28 patients taking long term frusemide (40-80 mg daily). Plasma potassium fell when supplements were stopped, and rose towards prior values on the potassium/frusemide combination, Diumide K. In a crossover study in 14 of these patients comparing equivalent doses of frusemide, Diumide K (frusemide 40 mg, potassium 8 mmol), bumetanide, and Burinex K (bumetanide 0.5 mg, potassium 7.7 mmol) plasma potassium was lower on frusemide than on bumetanide. On Diumide K and Burinex K plasma potassium rose significantly but did not reach the levels on prior therapy. Small doses of potassium in combined formulations seem to be effective in countering the mild hypokalaemia caused by loop diuretics.