NephrologyDialysis Transplantation
NephrologyDialysis Transplantation
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肾内科透析移植
DOI：
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发表时间：
2005
期刊：
影响因子：
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通讯作者：
K. Dholaria
中科院分区：
文献类型：
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作者：
Shivali Berera;A. Gomez;L. Arosemena;K. Bhamidimarri;K. Dholaria
先生，肾小管间质性肾炎（TIN）和移行细胞癌是公认的慢性镇痛药滥用的后遗症[1]。我们报告一例晚期肾衰竭继发于TIN和膀胱和肾盂中的过渡细胞肿瘤性疾病，与大量消耗非处方（OTC）抗酸制剂（Bisodol®，Whitehall Laboratories，都柏林）超过30年有关。医学文献中此前尚未对这种疾病相关性进行评论。患者是一名79岁男性，因持续6周的无痛性肉眼血尿而转诊。他抱怨说，他有焦虑症，但否认频率或犹豫。既往病史对慢性肾衰竭有重要意义，已在另一家医院监测数年。3年前进行的静脉尿路造影显示双侧肾造影不良。超声检查显示肾脏轮廓光滑，正常皮髓质分化消失。当时他的血清肌酐为393 umol/l。尚未对他的肾衰竭做出具体诊断。开始用硝苯地平治疗高血压，后来加用呋塞米和阿米洛利。此后不久，非胰岛素依赖型糖尿病发生，并通过饮食控制进行治疗。没有视网膜病变的证据。他在入院前7年曾发生心肌梗死，后来完全康复。家族史无异常。他拒绝饮酒，5年前戒烟。他是一名退休公务员，从未接触过工业化学品。他最初否认服用任何其他药物;然而，根据随后的诊断反复询问，发现每天服用10-20片比索洛尔®片剂治疗消化不良，持续30年。
Sir, Tubulointerstitial nephritis (TIN) and transitional-cell carcinoma are well-recognized sequelae of chronic analgesic abuse [1]. We report a case of advanced renal failure secondary to TIN and transitional-cell neoplastic disease in the bladder and renal pelvis associated with massive consumption of an over-the-counter (OTC) antacid preparation (Bisodol®, Whitehall Laboratories, Dublin) over 30 years. This disease association has not previously been commented upon in the medical literature. The patient is a 79-year-old man who was referred for evaluation of painless macroscopic haematuria ongoing for 6 weeks. He complained of nocturia, but denied frequency or hesitancy. Past medical history was significant for chronic renal failure, which had been monitored in another hospital for several years. An intravenous urogram performed 3 years previously showed poor nephrograms bilaterally. A sonographic examination revealed smooth renal outlines and loss of the normal corticomedullary differentiation. His serum creatinine was 393 umol/1 at that time. A specific diagnosis for his renal failure had not been made. Treatment of hypertension was begun with nifedipine; frusemide, and amiloride were added later. Non-insulin-dependent diabetes mellitus developed shortly thereafter and was treated by dietary manipulation. There was no evidence of retinopathy. He had sustained a myocardial infarction 7 years before admission from which he made a full recovery. Family history was unremarkable. He denied alcohol intake and had stopped smoking 5 years earlier. He was a retired civil servant and had never been exposed to industrial chemicals. He initially denied intake of any other medications; however, repeated questioning in light of the subsequent diagnoses revealed an ingestion of 10-20 Bisodol® tablets per day for 30 years for dyspepsia.