腎石灰化症を伴うHyperchloremic Renal Tubular Acidosisの1例

概要

論文の詳細を見る
A case of hyperchloremic renal tubular acidosis with nephrocalcinosis, a 15 year old male,. was reported. In urinary analysis; pH: 6.8, Uosm: 460mOsm/kg H_2O, protein: Sulfo. 5 gtt (+), glucose (-), amino acid (-), Sulkowitch test (+), urinary sediment: leucocyte (+), cystine crystal (-). In seruml electrolyte; Na 139.5mEq/L, C1 117.7mEq/L, K 4.43mEq/L, (after renal biopsy 2.9mEq/L), Ca 6.1mEq/L, P 2.8mg/dl. In arteria blood; pH: 9.315, pCO_2: 28.0mmHg, pO_2: 101mmHg, HCO^-_3: 18.45mEq/L. serum alkaline phosphatase: 20.0 Bod. Unit. An excretory urogram had showed almost normal renal function, but we had found the numerous small calculi in the bilateral renal parenchyma. So, we diagnosed this case the hyperchloremic renal tubular acidosis with nephrocalcinosis. In renal function; PSP, 15%/15', 32%/2° GFR, 74.1ml/min., RPF, 332.1ml/min. Investigating the osmolal clearance and free water clearance, the decrease of the urinary concentrating and diluting ability was observed. The hypoosmotic polyuria in this disease had not only taken part in the increase of the free water and the endogenous osmotic diuresis, but also hypokalemia due to this disease, had progressed polyuria in hypokalemia after renal biopsy. In addition, polyuria was resistant to vasopressin. There was high urinary pH in spite of the metabolic acidosis, so we presumed the defective H^+ excretion of the renal tubules. For this, we examined urinary pH, urinary titratable acidity, urinary ammonium excretion, potassium clearance and urinary Na/K before and after administration of ammonium chloride,. Diamox, and sodium thiosulfate. The lowering of cargonic anhydrase activity and the defective H^+ excretion of the renal tubules were confirmed. Moreover, we observed the evidences of the hyperparathyrodism in this case by the increase of urinary calcium excretion, the decrease of phosphate tubular reabsorption rate, the defacement of lamina dura of the teeth, and the administration of calcium chloride. The renal tubular function and the parathyrodal function in this disease were discussed.
社団法人日本泌尿器科学会の論文

腎石灰化症を伴うHyperchloremic Renal Tubular Acidosisの1例

スポンサーリンク

概要

著者

関連論文

スポンサーリンク