Yokoyama K, Ogura Y, Matsushita Y, Takemoto F, Hara S, Yamada A, Kawaguchi Y, Hosoya T
Kidney Center, Toranomon Hospital, Tokyo, Japan.
Clin Nephrol. 1998 Jul;50(1):60-3.
We experienced a patient on continuous ambulatory peritoneal dialysis (CAPD) who showed hypererythropoietinemia (Epo concentration: 86.7 mU/ml, normal range: 8-36 mU/ml), erythrocytosis, high renin concentration (26.5 pg/ml) and chronic hypotension. In this patient the erythrocytosis progressed along with exacerbation of the chronic severe hypotensive state. This patient had systemic circulatory insufficiency as suggested by the fact that he had a fibrous myocardium and an increased anion gap. We hypothesized that circulatory insufficiency due to chronic severe hypotension may lead to the stimulation of the Epo production, due to a decreased oxygen supply to peripheral tissues and/or to the stimulation of the renin angiotensin system even in patients with end-stage renal failure.
我们遇到一位持续非卧床腹膜透析（CAPD）患者，其表现为促红细胞生成素血症（促红细胞生成素浓度：86.7 mU/ml，正常范围：8 - 36 mU/ml）、红细胞增多、高肾素浓度（26.5 pg/ml）以及慢性低血压。在该患者中，红细胞增多随着慢性严重低血压状态的加重而进展。该患者存在系统性循环功能不全，依据是其有心肌纤维化和阴离子间隙增加。我们推测，即使在终末期肾衰竭患者中，慢性严重低血压导致的循环功能不全会因外周组织氧供应减少和/或肾素 - 血管紧张素系统的刺激而导致促红细胞生成素产生增加。
