草酸盐肾病合并2型糖尿病肾病致慢性肾脏病5期1例报道

A Case Report of Chronic Kidney Disease Stage 5 Induced by Oxalate Nephropathy Combined with Type 2 Diabetic Nephropathy

摘要: 目的：报道1例以急性肾损伤快速进展为慢性肾脏病5期，经肾活检确诊为草酸盐肾病合并轻度系膜增生性糖尿病肾病(IIa级)的病例，提高对草酸盐肾病与糖尿病肾病致快速肾衰的临床识别能力。方法：回顾性分析患者临床资料、实验室检查、影像学及肾脏病理结果，结合文献复习，对临床资料进行分析。结果：患者男，59岁，2型糖尿病4年，以双下肢水肿、纳差、乏力4天入院，血肌酐峰值2173.2 μmol/L，伴严重高钾血症、代谢性酸中毒、高度房室传导阻滞。急诊血液净化、纠正内环境后行肾穿刺活检，提示急性肾小管间质损伤伴草酸盐结晶沉积，合并轻度系膜增生性糖尿病肾病。予激素、补液、碱化尿液等治疗，肾功能未完全恢复，维持血液透析。结论：糖尿病合并高草酸负荷易诱发草酸盐肾病，快速致终末期肾病；早期肾活检、及时血液净化与针对性干预可改善预后。

Abstract: Objective: To report a case progressing rapidly from acute kidney injury to chronic kidney disease stage 5, pathologically confirmed as oxalate nephropathy complicated with mild mesangial proliferative diabetic nephropathy (Grade IIa) by renal biopsy, so as to improve clinical recognition of rapid renal failure caused by oxalate nephropathy and diabetic nephropathy. Methods: The clinical data, laboratory examinations, imaging findings and renal pathological results of the patient were retrospectively analyzed, and relevant literatures were reviewed. Results: A 59-year-old male patient with 4-year history of type 2 diabetes was admitted due to bilateral lower extremity edema, poor appetite and fatigue for 4 days. The peak serum creatinine reached 2173.2 μmol/L, accompanied by severe hyperkalemia, metabolic acidosis and high-grade atrioventricular block. Renal biopsy was performed after emergency blood purification and internal environment correction, which showed acute tubulointerstitial injury with oxalate crystal deposition complicated with mild mesangial proliferative diabetic nephropathy. After treatment with glucocorticoids, fluid replacement and urine alkalinization, renal function failed to fully recover, and the patient maintained hemodialysis. Conclusion: Diabetic patients with high oxalate load are prone to oxalate nephropathy, which rapidly progresses to end-stage renal disease. Early renal biopsy, timely blood purification and targeted intervention can improve patient prognosis.