University of Central Florida/HCA Graduate Medical Education Consortium Internal Medicine Residency Program, Department of Internal Medicine, University of Central Florida College of Medicine, Orlando, FL.
University of Central Florida/HCA Graduate Medical Education Consortium Internal Medicine Residency Program, Department of Internal Medicine, University of Central Florida College of Medicine, Orlando, FL.
Am J Kidney Dis. 2017 Nov;70(5):729-731. doi: 10.1053/j.ajkd.2017.06.021. Epub 2017 Aug 18.
Apremilast is a recently developed phosphodiesterase 4-inhibitory medication approved for use to treat psoriasis and psoriatic arthritis. We report a case of Fanconi syndrome and proximal renal tubular acidosis that was associated with this medication. Our patient was started on treatment with apremilast 2 weeks before his admission. On arrival, laboratory test results were significant for hypokalemia, hyperchloremic metabolic acidosis, low uric acid concentration, positive urine anion gap, and proteinuria, which resolved on discontinuation of the drug. Two months after the hospitalization, he was restarted on apremilast therapy; 17 days after resumption, the patient was admitted for similar laboratory values, which again improved when apremilast treatment was discontinued. After discharge, laboratory values remained normal without long-term electrolyte repletion. Proximal renal tubular acidosis (Fanconi syndrome) with quick correction of electrolyte concentrations on discontinuation of the drug was diagnosed. Our patient lacked evidence of other causes. Our patient fulfilled criteria associated with this disease and responded well off treatment with the offending agent. Literature review did not reveal prior cases associated with this medication.
阿普米司特是一种新研发的磷酸二酯酶 4 抑制剂，已被批准用于治疗银屑病和银屑病关节炎。我们报告了一例与该药物相关的范可尼综合征和近端肾小管酸中毒。我们的患者在入院前 2 周开始接受阿普米司特治疗。入院时，实验室检查结果显示血钾降低、高氯性代谢性酸中毒、尿酸浓度降低、尿阴离子间隙阳性和蛋白尿，停药后这些异常得到改善。住院 2 个月后，他重新开始接受阿普米司特治疗；恢复治疗 17 天后，患者因类似的实验室值再次入院，再次停药后改善。出院后，在未长期补充电解质的情况下，实验室值仍保持正常。诊断为药物引起的近端肾小管酸中毒（范可尼综合征），停药后电解质浓度迅速恢复正常。我们的患者缺乏其他病因的证据。我们的患者符合与这种疾病相关的标准，在停用致病药物后反应良好。文献复习未发现与该药物相关的先前病例。
