Nizze H, Schwabbauer P, Brachwitz C, Lange H
Institut für Pathologie, Universität Rostock.
Pathologe. 1997 Jul;18(4):328-34. doi: 10.1007/s002920050224.
A 36-year-old man known as chronic alcohol abuser presently suffered from arthralgia and showed bilateral petriefied kidneys by sonography and computed tomography. Because of an unclear renal failure a kidney biopsy was performed and presented typical chronic renal oxalosis with massive oxalate crystal deposits, tubular atrophy and interstitital fibrosis. Since the man had never shown signs of hyperoxaluria in his life before, a secondary oxalosis was supposed. The subsequently prompted exploration established a three to four times abuse of rocket fuel with cola lemonade 12 years before during the patient's army time as a marine soldier. Such fuels contain ethylene glycol (glysantin) as antifreeze commonly known to cause in toxic doses acute renal tubular necrosis with hyperoxaluria. The presented case, however, suggests a rare sublethal ethylene glycol poisoning with initial renal tubular damage, oxalate crystal deposition and subsequent chronic interstitial oxalate nephritis with tubular atrophy, interstitial fibrosis and chronic renal failure. Undergoing chronic hemodialysis, the patient died 5 months after the kidney biopsy diagnosis by acute heart failure. At autopsy, progressed chronic renal oxalosis could be confirmed. Decompensated oxalate cardiomyopathy with disseminated myocardial oxalate crystal deposits caused acute heart failure promoted by myocardial hypertrophy in renal hypertension.
一名36岁的男性，已知长期酗酒，目前患有关节痛，超声和计算机断层扫描显示双侧肾脏呈石化状态。由于肾衰竭原因不明，进行了肾活检，结果显示为典型的慢性肾草酸沉着症，伴有大量草酸晶体沉积、肾小管萎缩和间质纤维化。由于该男子此前一生中从未出现过高草酸尿症的迹象，推测为继发性草酸沉着症。随后的调查发现，该患者在12年前作为海军陆战队士兵服役期间，曾三到四次滥用含火箭燃料的可乐汽水。此类燃料含有乙二醇（防冻剂），众所周知，中毒剂量的乙二醇会导致急性肾小管坏死并伴有高草酸尿症。然而，本病例提示为罕见的亚致死性乙二醇中毒，初期表现为肾小管损伤、草酸晶体沉积，随后发展为慢性间质性草酸肾病，伴有肾小管萎缩、间质纤维化和慢性肾衰竭。在接受慢性血液透析治疗后，患者在肾活检诊断后5个月死于急性心力衰竭。尸检证实存在进展性慢性肾草酸沉着症。失代偿性草酸心肌病伴弥漫性心肌草酸晶体沉积，在肾性高血压导致的心肌肥大的促发下，引发了急性心力衰竭。
