收稿日期: 2024-06-13
网络出版日期: 2024-12-25
Type Ⅰ renal tubular acidosis caused by primary Sjögren syndrome with first diagnosis of hypokalemia: a case report
Received date: 2024-06-13
Online published: 2024-12-25
原发性干燥综合征(primary Sjögren syndrome, PSS)作为一种慢性系统性自身免疫性疾病,早期发病往往较为隐匿,患者多以其他系统疾病的临床表现首次就诊,针对其发病机制现暂无明确研究结论。该病除侵犯机体外分泌腺体外,肾脏也常是其受累器官,部分患者可发展为肾小管酸中毒(renal tubular acidosis, RTA),出现难治性低钾血症及相关临床表现,而目前临床尚缺乏有针对性的规范治疗手段。早期诊断该病可以及时干预患者的病情进展,避免或延缓相关系统受累,使患者的临床治疗达最大获益。现报道1例因反复肢体乏力1年入院,最终被诊断为PSS继发Ⅰ型RTA的病例,根据患者自身情况予硫酸羟氯喹调节免疫治疗及对症处理,最终患者的病情好转。
黄敏 , 左莹 . 以低钾血症首发症状的原发性干燥综合征致I型肾小管酸中毒1例报道[J]. 诊断学理论与实践, 2024 , 23(06) : 624 -627 . DOI: 10.16150/j.1671-2870.2024.06.010
Primary Sjögren syndrome (PSS) as a chronic systemic autoimmune disease, many patients with early hidden symptoms of presented the clinical manifestations of other systemic diseases for the first time, and its pathogenesis was not clear yet. PSS could invade the exocrine glands of body, and the kidney was also the susceptible organ in PSS. Some patients could develop to renal tubular acidosis, and lead to refractory hypokalemia and related clinical manifestations. As lack of effective treatment, the early diagnosis and intervention of the disease could avoid damage or delay the involvement of related organs and maximize the benefits of clinical treatment. This paper reported a patient, who was admitted to hospital with chief complain of repeated limb weakness for one year, was diagnosed as type I renal tubular acidosis secondary to primary Sjögren syndrome. The patients received symptomatic treatment and hydroxychloroquine sulfate immunotherapy, and the symptoms were resolved eventually.
Key words: Primary Sjögren syndrome; Renal tubular acidosis; Hypokalemia; Diagnosis
[1] | Mariette X, Criswell LA. Primary Sj?gren’s Syndrome[J]. N Engl J Med, 2018, 378(10):931-939. |
[2] | 中华医学会风湿病学分会. 干燥综合征诊断及治疗指南[J]. 中华风湿病学杂志, 2010, 14(11):766-768. |
Chinese rheumatology association. Guidelines on the diag-nosis and management of Sj?gren’s syndrome[J]. Chin J Rheumatol, 2010, 14(11):766-768. | |
[3] | 张文, 厉小梅, 徐东, 等. 原发性干燥综合征诊疗规范[J]. 中华内科杂志, 2020, 59(4):269-276. |
Zhang W, Li XM, Xu D, et al. Recommendations of diagnosis and treatment of primary Sj?gren’s syndrome in China[J]. Chin J Intern Med, 2020, 59(4):269-276. | |
[4] | 姚血明, 侯雷, 曾苹, 等. 干燥综合征误诊原因分析[J]. 风湿病与关节炎, 2020, 9(1):28-30. |
Yao XM, Hou L, Zeng P, et al. Misdiagnosed causes analysis of Sj?gren’s syndrome[J]. Rheum Arthritis, 2020, 9(1):28-30. | |
[5] | 韩瑞红, 赵克中. 干燥综合征引发严重低钾血症致心脏骤停一例[J]. 天津医药, 2013, 41(2):180-181. |
Han RH, Zhao KZ. Cardiac arrest due to severe hypokalemia caused by Sj?gren’s syndrome: a case report[J]. Tianjin Med J, 2013, 41(2):180-181. | |
[6] | Varlamov EV, Langlois F, Vila G, et al. Management of endocrine disease: cardiovascular risk assessment, thromboembolism, and infection prevention in Cushing’s syndrome: a practical approach[J]. Eur J Endocrinol, 2021, 184(5):R207-R224. |
[7] | Torregrosa Prats JV, Santos Rodríguez F, González Parra E, et al. Distar renal tubular acidosis (dRTA): epidemiological, diagnostics, clinical follow-up and therapeutical issues. Nephrologists cohort survey outcome[J]. Nefrologia (Engl Ed), 2021, 41(1):62-68. |
[8] | Goules A, Geetha D, Arend LJ, et al. Renal involvement in primary Sj?gren’s syndrome: natural history and treatment outcome[J]. Clin Exp Rheumatol, 2019, 37 Suppl 118(3):123-132. |
[9] | Furqan S, Banu S, Ram N. Osteoporosis complicating renal tubular acidosis in association with Sj?gren’s Syndrome[J]. Cureus. 2021 Sep 29;13(9):e18373. |
[10] | Palmer BF, Kelepouris E, Clegg DJ. Renal tubular acidosis and management strategies: a narrative review[J]. Adv Ther, 2021, 38(2):949-968. |
[11] | Zhang L, Xu B, Niu Y, et al. Familial distal renal tubular acidosis[J]. J Int Med Res, 2021, 49(3):3000605211000 533. |
[12] | Giglio S, Montini G, Trepiccione F, et al. Distal renal tubular acidosis: a systematic approach from diagnosis to treatment[J]. J Nephrol, 2021, 34(6):2073-2083. |
[13] | Liu Y, Hirayama M, Cui X, et al. Effectiveness of autologous serum eye drops combined with punctal plugs for the treatment of Sj?gren syndrome-related dry eye[J]. Cornea, 2015, 34(10):1214-1220. |
[14] | Ahn H, Ji YW, Jun I, et al. Comparison of treatment modalities for dry eye in primary Sj?gren’s syndrome[J]. J Clin Med, 2022, 11(2):463. |
[15] | Ogawa Y, Takeuchi T, Tsubota K. Autoimmune epithelitis and chronic inflammation in Sj?gren’s syndrome-related dry eye disease[J]. Int J Mol Sci, 2021, 22(21):11820. |
[16] | Negrini S, Emmi G, Greco M, et al. Sj?gren’s syndrome: a systemic autoimmune disease[J]. Clin Exp Med, 2022, 22(1):9-25. |
[17] | 刘霞, 徐婷, 吴敏. 外泌体在自身免疫性疾病中的研究进展[J]. 中国临床研究, 2023, 36(2):238-241. |
LIU X, XU T, WU M. Research progress of extracellular vesicles in autoimmune diseases[J]. Chin Clin Res, 2023, 36(2):238-241. | |
[18] | 孟德钎, 李鞠, 李永胜, 等. 艾拉莫德联合甲泼尼龙、硫酸羟氯喹对原发性干燥综合征合并间质性肺病的疗效[J]. 中国临床研究, 2023, 36(1):85-89. |
MENG D C, LI J, LI Y S, et al. The efficacy of alamod combined with methylprednisolone and hydroxychloroquine sulfate in the treatment of primary Sjogren's syndrome complicated with interstitial lung disease[J]. Chin Clinl Res, 2023, 36(1):85-89. |
/
〈 |
|
〉 |