HYPERKALEMIC DISTAL RENAL TUBULAR-ACIDOSIS ASSOCIATED WITH OBSTRUCTIVE UROPATHY
HYPERKALEMIC DISTAL RENAL TUBULAR-ACIDOSIS ASSOCIATED WITH OBSTRUCTIVE UROPATHY
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DOI：
10.1056/nejm198102123040701
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发表时间：
1981-01-01
影响因子：
158.5
通讯作者：
KURTZMAN, NA
中科院分区：
文献类型：
--
作者：
BATLLE, DC;ARRUDA, JAL;KURTZMAN, NA
研究人员对 13 名患有梗阻性尿病和高钾性代谢性酸中毒的患者的肾功能进行了研究，以了解该疾病的发病机制。所有患者的基线钾排泄分数均低于肾小球滤过率相似的对照组。 11 名患者接受了乙酰唑胺治疗，但未能将钾排泄分数增加至正常水平。在 5 名患者中，钾排泄受损与铵排泄减少、尿 pH < 5.5（5.18 .+-. 0.07，平均值 .+-. SEM [平均值标准误]）和醛固酮缺乏有关。其余 8 名患者的尿液 pH 值未降至 5.5 以下（6.4.+-.0.2）并伴有酸中毒。通过施用盐皮质激素和硫酸钠来降低尿液 pH 值并将钾排泄分数增加至正常的尝试失败了。梗阻性尿路病患者可能会出现高钾血症远端肾小管酸中毒综合征。在一些患者中，这种综合征是由远端肾单位 H 和 K 分泌缺陷引起的，而不是醛固酮缺乏所致。梗阻性尿路病应纳入高钾性酸中毒和肾功能不全的鉴别诊断中。
Renal function was studied in 13 patients with obstructive uropathy and hyperkalemic metabolic acidosis to characterize the pathogenesis of this disorder. Base-line fractional K excretion was lower in all patients than in controls with similar glomerular filtration rates. Acetazolamide was given to 11 patients but failed to increase fractional K excretion to normal. In 5 patients, impaired K excretion was associated with decreased ammonium excretion, a urinary pH < 5.5 (5.18 .+-. 0.07, mean .+-. SEM [standard error of the mean]) and aldosterone deficiency. In the remaining 8 patients, the urinary pH did not fall below 5.5 (6.4 .+-. 0.2) with acidosis. Attempts to lower urinary pH and increase fractional K excretion to normal by administering a mineralocorticoid and sodium sulfate failed. A syndrome of hyperkalemic distal renal tubular acidosis may occur in patients with obstructive uropathy. In some patients, this syndrome results from a defect in H and K secretion in the distal nephron rather than from aldosterone deficiency. Obstructive uropathy should be included in the differential diagnosis of hyperkalemic acidosis and renal insufficiency.