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一例获得性肾性范科尼综合征的有趣病例。

An Interesting Case of Acquired Renal Fanconi Syndrome.

作者信息

Senthilnathan Subbiah, Nallusamy Gunasekaran, Varadaraj Priyadarshini

机构信息

Internal Medicine, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND.

出版信息

Cureus. 2024 Jul 23;16(7):e65208. doi: 10.7759/cureus.65208. eCollection 2024 Jul.

Abstract

Renal Fanconi syndrome (RFS) is a proximal tubular dysfunction characterized by abnormalities in the absorption of electrolytes and substances by the proximal tubule. It can manifest as proteinuria, glycosuria, aminoaciduria, phosphaturia, and proximal renal tubular acidosis (RTA) type 2. Heavy metal-induced nephrotoxicity from heavy metals such as iron, cadmium, mercury, and lead is a common risk factor for type 2 RTA. Environmental contamination or prolonged contact with pesticides, such as lead arsenate, Bordeaux mixture, and copper sulfate, may also contribute to heavy metal exposure. A 25-year-old female patient with RFS was diagnosed, and the bicarbonate loading test showed typical features of generalized proximal tubular dysfunction and proximal RTA. A metabolic disorder in the bone was the predominant feature, and renal wasting of phosphorus and calcium was linked to osteoporosis and increased intact parathyroid hormone (PTH) levels. Due to reports of zoledronate-induced RFS, calcitriol was administered instead of bisphosphates. Drug-induced nephrotoxicity is the most probable cause of adult-onset RFS. Acute tubulointerstitial nephritis is a plausible hypothesis, and treatment was based on observations and assessments that improved clinical outcomes. Ayurvedic medicine, popular in India due to its traditional roots and cultural aversion to artificial drugs, has high levels of heavy metal content.

摘要

肾性范科尼综合征(RFS)是一种近端肾小管功能障碍,其特征是近端小管对电解质和物质的吸收异常。它可表现为蛋白尿、糖尿、氨基酸尿、磷酸盐尿和2型近端肾小管酸中毒(RTA)。铁、镉、汞和铅等重金属引起的重金属诱导的肾毒性是2型RTA的常见危险因素。环境污染或长期接触杀虫剂,如砷酸铅、波尔多液和硫酸铜,也可能导致重金属暴露。一名25岁患有RFS的女性患者被诊断出来了,碳酸氢盐负荷试验显示出全身性近端肾小管功能障碍和近端RTA的典型特征。骨骼中的代谢紊乱是主要特征,肾脏对磷和钙的消耗与骨质疏松症和完整甲状旁腺激素(PTH)水平升高有关。由于有唑来膦酸诱导RFS的报道,因此给予骨化三醇而非双膦酸盐。药物性肾毒性是成人起病型RFS最可能的原因。急性肾小管间质性肾炎是一个合理的假设,治疗基于改善临床结果的观察和评估。阿育吠陀医学在印度很受欢迎,因其传统根源和对人工药物的文化反感,其重金属含量很高。

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