严重肾积水并发原发性醛固酮增多症:病例报告和文献综述。

IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Journal of Medical Case Reports Pub Date : 2024-10-06 DOI:10.1186/s13256-024-04798-4
Jianjuan Sun, Qiurong Zeng, Longbing Lai, Mingjun Gu, Dingrong Liu, Guangxiu Wu, Chuan Peng, Shuming Yang, Qifu Li, Jiangang Lu
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引用次数: 0

摘要

背景:原发性醛固酮增多症的特点是血浆醛固酮高而肾素低。建议通过血浆醛固酮与肾素的比值进行筛查。严重肾积水会导致肾实质缺血,从而导致肾素分泌增加。由于肾素的非抑制性可能会导致醛固酮与肾素比值检测结果呈阴性,因此同时出现严重肾积水和原发性醛固酮增多症的患者很难诊断:一名 54 岁的中国汉族男子在 13 年前被诊断出患有高血压和严重低钾血症(最低 1.57 mmol/L),同时还被诊断出因左侧先天性输尿管狭窄而导致严重肾积水。他的临床特征表明他患有原发性醛固酮增多症,但每次接受原发性醛固酮增多症筛查时,醛固酮与肾素的比值结果都是阴性。由于没有对原发性醛固酮增多症进行进一步治疗,患者患上了严重的低钾血症,13 年来,他每天口服 12-15 克氯化钾,使血钾保持在 3.0 至 3.5 毫摩尔/升(参考值为 3.5 至 5.5 毫摩尔/升)之间,并多次入住重症监护室进行抢救。入院时,虽然患者的醛固酮-肾素比值结果为阴性,但我们还是为其做了生理盐水压力试验和卡托普利抑制试验,结果显示试验后血浆醛固酮水平并不比试验前低。肾上腺增强计算机断层扫描提示左侧肾上腺腺瘤,肾上腺静脉取样结果显示左侧为优势侧。因此,患者接受了腹腔镜下左侧肾上腺全切除术。两周后,患者出现了短期肾功能损害和高钾血症,但经过补液等治疗后,肾功能和血钾恢复正常。1 年后,患者的生化检查结果和临床症状完全正常:我们建议,对于临床高度怀疑原发性醛固酮增多症的患者,必须结合临床特征评估进行综合分析,如严重肾积水,如果肾素在正常范围内或筛查和诊断性检查中醛固酮与肾素比值结果为阴性,必要时应进行肾上腺静脉采样。这有助于避免误诊,并有助于治疗严重肾积水和原发性醛固酮增多症患者。
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Severe hydronephrosis complicated with primary aldosteronism: a case report and review of the literature.

Background: Primary aldosteronism is characterized by high plasma aldosterone and low renin. The plasma aldosterone-to-renin ratio is recommended for screening. Severe hydronephrosis leads to renal parenchymal ischemia, resulting in increased renin secretion. Since nonsuppression of renin may cause a negative result in the aldosterone-to-renin ratio test, severe hydronephrosis and primary aldosteronism occurring simultaneously in a patient are challenging to diagnose.

Case presentation: A 54-year-old Chinese man of Han ethnicity was diagnosed with hypertension and severe hypokalemia (minimum 1.57 mmol/L) 13 years prior, and was also diagnosed with severe hydronephrosis due to congenital ureteral stenosis on the left side. His clinical features suggested primary aldosteronism, but the aldosterone-to-renin ratio result of the patient was negative every time he underwent the primary aldosteronism screening test. No further treatment for primary aldosteronism was performed, which led the patient to suffer from severe hypokalemia, such that he was taking 12-15 g/day potassium chloride orally to keep his blood potassium between 3.0 and 3.5 mmol/L (reference value, 3.5-5.5 mmol/L) for 13 years, and the patient needed to be hospitalized in the intensive care unit for rescue several times. At admission, although the aldosterone-to-renin ratio result of the patient was negative, we still did the saline stress test and captopril inhibition test, and the results showed that the plasma aldosterone level was not lower after the test than before the test. Adrenal enhanced computed tomography suggested an adenoma in the left adrenal gland, and the results of adrenal vein sampling suggested that the left side was the dominant side. Therefore, laparoscopic total resection of the left adrenal gland was performed, and 2 weeks later, the patient developed short-term renal function impairment and hyperkalemia, but his renal function and blood potassium returned to normal after treatment that included fluid rehydration. The patient's biochemical test results and clinical symptoms were completely normal after 1 year.

Conclusion: We suggest that for patients with a high suspicion of primary aldosteronism in the clinic, comprehensive analysis must be performed in combination with clinical characteristic assessments, such as severe hydronephrosis, if renin is within the normal range or if the aldosterone-to-renin ratio result is negative at screening and diagnostic tests, and adrenal vein sampling should be performed if necessary. It can help avoid misdiagnoses and contribute to the treatment of patients with severe hydronephrosis and primary aldosteronism.

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来源期刊
Journal of Medical Case Reports
Journal of Medical Case Reports Medicine-Medicine (all)
CiteScore
1.50
自引率
0.00%
发文量
436
期刊介绍: JMCR is an open access, peer-reviewed online journal that will consider any original case report that expands the field of general medical knowledge. Reports should show one of the following: 1. Unreported or unusual side effects or adverse interactions involving medications 2. Unexpected or unusual presentations of a disease 3. New associations or variations in disease processes 4. Presentations, diagnoses and/or management of new and emerging diseases 5. An unexpected association between diseases or symptoms 6. An unexpected event in the course of observing or treating a patient 7. Findings that shed new light on the possible pathogenesis of a disease or an adverse effect
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