Hoorn Ewout J, Zietse Robert
Erasmus Medical Center, Rotterdam, The Netherlands.
Nat Clin Pract Nephrol. 2007 Mar;3(3):171-5. doi: 10.1038/ncpneph0424.
A 39-year-old male with multiple myeloma was admitted for treatment with melphalan and autologous stem cell reinfusion. He presented with hypokalemia and hyperchloremic non-anion-gap metabolic acidosis with a high urinary pH. He also had hypomagnesemia, hypophosphatemia, hypouricemia, proteinuria and glucosuria. The patient subsequently developed polyuria with a low urine osmolality, hypernatremia and, finally, acute renal failure.
Physical examination, blood and urine analyses, kidney biopsy and tonicity balance.
Fanconi syndrome with proximal (type II) renal tubular acidosis caused by myeloma kidney. Renal tubular acidosis was complicated by probable nephrogenic diabetes insipidus and acute renal failure.
Potassium supplementation, sodium bicarbonate therapy, intravenous fluid therapy and dialysis.
一名39岁的多发性骨髓瘤男性患者因美法仑治疗及自体干细胞回输入院。他出现低钾血症、高氯性非阴离子间隙代谢性酸中毒且尿pH值高。他还存在低镁血症、低磷血症、低尿酸血症、蛋白尿和糖尿。该患者随后出现多尿，尿渗透压降低、高钠血症，最终发展为急性肾衰竭。
体格检查、血液和尿液分析、肾活检及张力平衡检查。
骨髓瘤肾病所致的范科尼综合征伴近端（II型）肾小管酸中毒。肾小管酸中毒并发可能的肾性尿崩症和急性肾衰竭。
补钾、碳酸氢钠治疗、静脉补液治疗及透析。
