Verde Frederico A Lima, Verde Francisco A A Lima, Veronese Francisco José V, Neto Augusto S, Fuc Galdino, Verde Emir M Lima
Instituto de Nefrologia do Ceará, Fortaleza, Ceará, Brasil.
Rev Inst Med Trop Sao Paulo. 2010 Sep-Oct;52(5):253-8. doi: 10.1590/s0036-46652010000500006.
There are few reports linking hyponatremia and visceral leishmaniasis (kala-azar). This is a study of 55 consecutive kala-azar patients and 20 normal individuals as a control group. Hyponatremia and serum hypo-osmolality were detected in 100% of kala-azar patients. High first morning urine osmolality (750.0 ± 52.0 vs. 894.5 ± 30.0mOsm/kg H₂O, p < 0.05), and high 24-hour urine osmolality (426.0 ± 167.0 vs. 514.6 ± 132.0 mOsm/kg H₂O, p < 0.05) demonstrated persistent antidiuretic hormone secretion. Urinary sodium was high (82.3 ± 44.2 vs.110.3 ± 34.7 mEq/L, p < 0.05). Low seric uric acid occurred in 61.8% of patients and increased fractional urinary uric acid excretion was detected in 74.5% of them. Increased glomerular filtration rate was present in 25.4% of patients. There was no evidence of extracellular volume depletion. Normal plasma ADH levels were observed in kala-azar patients. No endocrine or renal dysfunction was detected. It is possible that most hyponatremic kala-azar patients present the syndrome of inappropriate antidiuretic hormone secretion.
很少有报告将低钠血症与内脏利什曼病（黑热病）联系起来。本研究纳入了55例连续的黑热病患者，并以20名正常个体作为对照组。100%的黑热病患者检测到低钠血症和血清低渗。晨尿渗透压较高（750.0±52.0对894.5±30.0mOsm/kg H₂O，p<0.05），24小时尿渗透压较高（426.0±167.0对514.6±132.0 mOsm/kg H₂O，p<0.05），表明抗利尿激素持续分泌。尿钠较高（82.3±44.2对110.3±34.7 mEq/L，p<0.05）。61.8%的患者血清尿酸降低，74.5%的患者尿尿酸排泄分数增加。25.4%的患者肾小球滤过率增加。没有细胞外液量减少的证据。在黑热病患者中观察到血浆抗利尿激素水平正常。未检测到内分泌或肾功能障碍。大多数低钠血症黑热病患者可能存在抗利尿激素分泌不当综合征。
