Stepien Karolina M, Prinsloo Peter, Hitch Tony, McCulloch Thomas A, Sims Rebecca
Clinical Pathology Department, Nottingham University Hospitals Trust, Nottingham NG5 1PB, UK.
Int J Nephrol. 2011;2011:679160. doi: 10.4061/2011/679160. Epub 2011 Jul 19.
A 29-year old female presented with a one-week history of vomiting, diarrhoea, abdominal pain, and headache. On admission, she had acute renal failure requiring dialysis. Tests revealed a hemolytic anemia with thrombocytopenia. An initial diagnosis of thrombotic thrombocytopenic microangiopathy was made and plasma exchange was instigated. However, renal biopsy did not show thrombotic microangiopathy but instead revealed acute kidney injury with mild tubulointerstitial nephritis and numerous oxalate crystals, predominantly in the distal tubules. The patient had been taking large doses (>1100 mg daily) of vitamin C for many months. She also gave a history of sclerotherapy using injections of an ethylene glycol derivative for superficial leg veins. The patient completed five sessions of plasma exchange and was able to discontinue dialysis. She eventually achieved full renal recovery. She has now discontinued sclerotherapy and vitamin supplementation.
一名29岁女性，有一周的呕吐、腹泻、腹痛和头痛病史。入院时，她患有急性肾衰竭，需要透析。检查发现溶血性贫血伴血小板减少。初步诊断为血栓性血小板减少性微血管病，并开始进行血浆置换。然而，肾活检未显示血栓性微血管病，而是显示急性肾损伤，伴有轻度肾小管间质性肾炎和大量草酸盐结晶，主要位于远端肾小管。该患者数月来一直在服用大剂量（每日>1100毫克）的维生素C。她还曾有使用乙二醇衍生物注射治疗腿部浅表静脉硬化疗法的病史。患者完成了五次血浆置换，能够停止透析。她最终实现了肾脏完全恢复。她现在已经停止了硬化疗法和维生素补充。
