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NEJM：锂肾病-病例报道

2018-03-15 xing.T MedSci原创

锂肾病骨折肾囊肿
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作为评估的一部分，对腹部和骨盆进行增强扫描，结果显示双侧肾皮质和髓质有许多小的肾囊肿（轴向[如图A]和冠状面[如图B]视图，用非标准的窗口来增强囊肿的可视性）。众所周知，锂离子会引起肾小管间质肾病，这可能在多发性小囊肿的影像学上被发现。

患者为一名59岁男性，既往有双相情感障碍病史，因跌倒后被送往医院就诊。他被诊断为头部和脊柱多发骨折；骨折接受非手术治疗。

在住院期间，他的尿液排出量从每天4升到6升不等。病人吃过27年的锂离子，并因轻度甲状旁腺功能亢进、肾功能不全（血清肌酐水平，1.5毫克每分升[130μmol/L]）在本次就诊前年停止服药。他的血清钠水平从138μmol/L上升到149μmol/L，伴有尿低渗透压（262 mOsm/kg）。尿渗透压并未因服用去氨加压素而增加，这证实诊断为肾性尿崩症。



作为评估的一部分，对腹部和骨盆进行增强扫描，结果显示双侧肾皮质和髓质有许多小的肾囊肿（轴向[如图A]和冠状面[如图B]视图，用非标准的窗口来增强囊肿的可视性）。众所周知，锂离子会引起肾小管间质肾病，这可能在多发性小囊肿的影像学上被发现。

该病人的治疗包括低盐饮食和大量摄入液体。他的血钠水平正常，他被要求出院到康复中心治疗。

原始出处：

Aditya S. Pawar,et al. Lithium-Induced Nephropathy.N Engl J Med 2018. http://www.nejm.org/doi/full/10.1056/NEJMicm1709438

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    2018-03-27 DEXTER3150

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  2. [GetPortalCommentsPageByObjectIdResponse(id=1721737, encodeId=a4d51e21737c9, content=<a href='/topic/show?id=34439669547' target=_blank style='color:#2F92EE;'>#锂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=113, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96695, encryptionId=34439669547, topicName=锂)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f7a933073777, createdName=DEXTER3150, createdTime=Tue Mar 27 00:33:00 CST 2018, time=2018-03-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=296422, encodeId=c30b296422bd, content=一起学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/TDiaAWyicHgedzX3wKo3qcxudVJib7AfibfvNeufHRF2jG3Bw8MmZyWjIhtBV1mpJI7Sy9n7RcBKK5t3CuOKuOFxkg/0, createdBy=dd702206933, createdName=wzb521zf, createdTime=Thu Mar 15 08:11:42 CST 2018, time=2018-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=296416, encodeId=174f2964169c, content=学习谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Thu Mar 15 08:08:23 CST 2018, time=2018-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=296406, encodeId=8157296406ba, content=谢谢分享.学习了谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=113, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Thu Mar 15 07:56:33 CST 2018, time=2018-03-15, status=1, ipAttribution=)]
    2018-03-15 wzb521zf

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  3. [GetPortalCommentsPageByObjectIdResponse(id=1721737, encodeId=a4d51e21737c9, content=<a href='/topic/show?id=34439669547' target=_blank style='color:#2F92EE;'>#锂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=113, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96695, encryptionId=34439669547, topicName=锂)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f7a933073777, createdName=DEXTER3150, createdTime=Tue Mar 27 00:33:00 CST 2018, time=2018-03-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=296422, encodeId=c30b296422bd, content=一起学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/TDiaAWyicHgedzX3wKo3qcxudVJib7AfibfvNeufHRF2jG3Bw8MmZyWjIhtBV1mpJI7Sy9n7RcBKK5t3CuOKuOFxkg/0, createdBy=dd702206933, createdName=wzb521zf, createdTime=Thu Mar 15 08:11:42 CST 2018, time=2018-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=296416, encodeId=174f2964169c, content=学习谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Thu Mar 15 08:08:23 CST 2018, time=2018-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=296406, encodeId=8157296406ba, content=谢谢分享.学习了谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=113, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Thu Mar 15 07:56:33 CST 2018, time=2018-03-15, status=1, ipAttribution=)]
    2018-03-15 龙胆草

    学习谢谢分享

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  4. [GetPortalCommentsPageByObjectIdResponse(id=1721737, encodeId=a4d51e21737c9, content=<a href='/topic/show?id=34439669547' target=_blank style='color:#2F92EE;'>#锂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=113, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96695, encryptionId=34439669547, topicName=锂)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f7a933073777, createdName=DEXTER3150, createdTime=Tue Mar 27 00:33:00 CST 2018, time=2018-03-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=296422, encodeId=c30b296422bd, content=一起学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/TDiaAWyicHgedzX3wKo3qcxudVJib7AfibfvNeufHRF2jG3Bw8MmZyWjIhtBV1mpJI7Sy9n7RcBKK5t3CuOKuOFxkg/0, createdBy=dd702206933, createdName=wzb521zf, createdTime=Thu Mar 15 08:11:42 CST 2018, time=2018-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=296416, encodeId=174f2964169c, content=学习谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Thu Mar 15 08:08:23 CST 2018, time=2018-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=296406, encodeId=8157296406ba, content=谢谢分享.学习了谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=113, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Thu Mar 15 07:56:33 CST 2018, time=2018-03-15, status=1, ipAttribution=)]
    2018-03-15 明月清辉

    谢谢分享.学习了谢谢分享.学习了

    0

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