每日一题_2023.01.17

A 33-year-old man from upstate New York comes to his physician because of flu-like symptoms after a camping trip one week ago. He also notes a troubling rash on his leg that has moved slowly from his ankle to his midthigh over the past several days. The physician diagnoses Lyme disease and prescribes tetracycline. The patient recently lost his prescription benefits through his health insurance plan, so he uses an old bottle of tetracycline from his medicine cabinet at home. One week later the man presents to the emergency department with signs of dehydration and a creatinine level of 3.6, up from his baseline of 0.6. Which of the following renal conditions is this man most likely experiencing?

一名来自纽约州北部的 33 岁男子在一周前参加野营旅行后，因出现流感样症状而去看医生。 他还注意到他的腿上有一个令人不安的皮疹，在过去几天里，皮疹已经从他的脚踝慢慢移动到大腿中部。 医生诊断出莱姆病并开了四环素。 该患者最近失去了通过他的健康保险计划获得的处方福利，因此他使用了家中药柜中的一瓶旧四环素。 一周后，该男子因脱水迹象和肌酐水平从他的基线 0.6 上升到 3.6 到急诊室就诊。 此人最有可能患有以下哪种肾脏疾病？

(A) Acute tubular necrosis 急性肾小管坏死

(B) Glomerulonephritis 肾小球肾炎

(C) Kidney stones 肾结石

(D) Renal papillary necrosis 肾乳头坏死

(E) Renal tubular dysfunction 肾小管功能障碍

答案解析：

降解的四环素与 Fanconi 综合征有关，Fanconi 综合征是一种近端小管功能障碍，会导致蛋白质、葡萄糖和必需矿物质（尤其是钙和镁）的严重流失。 四环素的主要降解产物是脱水-4-外四环素，它有毒并在近端肾小管中蓄积引起范可尼综合征。 由于尿液中水分和溶质流失过多，患者会出现烦渴、多尿和脱水症状。

正确答案：E