Uremic pruritus
Uremic pruritus
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DOI：
10.1038/sj.ki.5002197
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发表时间：
2007-08-01
影响因子：
19.6
通讯作者：
Singh, A. K.
中科院分区：
文献类型：
--
作者：
Keithi-Reddy, S. R.;Patel, T. V.;Singh, A. K.
一名患有糖尿病、高血压和5期慢性肾病的51岁非裔美国男性，表现为持续1个月的强烈全身瘙痒以及持续3天的恶心和呕吐。他在瘙痒发作之前没有皮肤损伤。患者描述瘙痒主要发生在白天。他否认有任何职业接触。他的既往病史也有丙型肝炎。他的用药包括阿司匹林、中性鱼精蛋白哈格多恩胰岛素、骨化三醇、醋酸钙、硝苯地平、可乐定、赖诺普利和呋塞米。他已经以不同剂量服用这些药物超过1年。偶尔吸烟和饮酒以及每4-6周吸食一次快克可卡因的社会史是重要的。无明显家族史。与系统审查相关的是无发热、体重减轻、疲乏或不适病史。无黄疸病史。他否认口腔或生殖器溃疡。就诊时血压为158/92 mm Hg，心率为80次/分。患者无发热，呼吸频率正常。病人脸上有粉状沉积物。他没有黄疸。他有双侧踏板凹陷性水肿。皮肤检查显示全身性干燥症，背部、胸部、腹部、上下肢多发苔藓样斑块，累及90%以上体表。双侧下肢（图1a）和背部（图1b）有多个2- 4 mm的剥脱性结节。在他的手指或脚趾蹼之间没有洞穴或水泡。口腔和生殖器正常。其余检查无异常。入院时血液检查显示血清电解质在正常范围内。血尿素氮：93 mg/dl（正常范围8- 18 mg/ dl）;血清肌酐：10.8 mg/dl;血糖：155 mg/dl;肝功能检查（包括转氨酶和胆红素）在正常范围内;血清白蛋白：3.6 g/dl（正常范围3-5 g/dl）;血清钙：7.7 mg/dl;血清磷酸盐：4.4 mg/dl;全段甲状旁腺激素（iPTH）：266 pg/ml。白色血细胞计数为9.58 x 10（6）/l（正常范围4.5-11 x 10（6）/l），白色血细胞计数分类：分叶中性粒细胞54%（正常范围54 - 62%），淋巴细胞15.9%（正常范围25-33%），单核细胞5.8%（正常范围3-7%），嗜酸性粒细胞24%和小于5%的带状。外周血涂片检查发现小红细胞不均匀，有毛刺细胞和球形红细胞。抗核抗体阴性。促甲状腺激素为2.38mU/ml。
A 51-year-old African American male with diabetes, hypertension, and stage 5 chronic kidney disease presents with intense generalized itching of 1-month duration as well as nausea and vomiting of 3 days duration. He had no skin lesions that preceded the onset of itching. The patient described the itching as predominantly occurring during the day. He denied any occupational exposure. His past medical history was notable also for hepatitis C. His medications included aspirin, neutral protamine hagedorn insulin, calcitriol, calcium acetate, nifedipine, clonidine, lisinopril, and furosemide. He had been on these medications for more than 1 year at varying doses. Social history was significant for occasional tobacco and alcohol use as well as crack-cocaine consumption once every 4-6 weeks. There was no significant family history. Pertinent in the review of systems was the absence of a history of fever, weight loss, fatigue, or malaise. There was no history of jaundice. He denied oral or genital ulcers. Blood pressure at presentation was 158/92mm Hg and heart rate 80 beats/min. He was afebrile and had a normal respiratory rate. The patient had powdery deposits on his face. He was anicteric. He had bilateral pedal pitting edema. Examination of skin revealed generalized xerosis with multiple lichenified patches on the back, chest, abdomen, upper and lower extremities with more than 90% body surface involved. There were multiple excoriated 2-4mm nodules on the lower extremities bilaterally (Figure 1a) and on the back (Figure 1b). There were no burrows or vesicles between his finger or toe web spaces. The oral cavity and genitalia were normal. The rest of the examination was unremarkable. Blood work on admission revealed serum electrolytes within the normal range. Blood urea nitrogen, 93mg/dl (normal range 8-18mg/ dl); serum creatinine, 10.8mg/dl; blood glucose, 155mg/dl; liver function tests including transaminases and bilirubin were within normal limits; serum albumin, 3.6 g/dl (normal range 3-5 g/dl); serum calcium, 7.7mg/dl; serum phosphate, 4.4mg/dl; intactparathyroid hormone (iPTH), 266 pg/ml. White blood cell count was 9.58 x 10(6)/l (normal range 4.5-11 x 10(6)/l), white blood cell count differential: segmented neutrophils 54% (normal range 54 - 62%), lymphocytes 15.9% (normal range 25-33%), and monocytes 5.8% ( normal range 3-7%), eosinophils 24% and less than 5% band forms. Peripheral smear examination revealed anisomicrocytosis with burr cells and spherocytes. Antinuclear antibody was negative. Thyrotropic hormone was 2.38mU/ml.