每日一题_2023.07.22

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岁男子因一周前露营旅行后出现流感样症状来找他的医生。他还注意到，过去几天，他的腿上有一个令人不安的皮疹，从脚踝慢慢蔓延到大腿中部。医生诊断莱姆病，开出四环素。该患者最近因健康保险计划而失去了处方福利，所以他使用了家里药柜里的一瓶旧四环素。1周后，该男子到急诊科就诊，有脱水迹象，肌酐水平从基线的0.6上升至3.6。这名男子最有可能经历下列哪种肾脏疾病?

(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：

四环素降解与范可尼综合征相关，范可尼综合征是一种近端肾小管功能障碍，可导致蛋白质、葡萄糖和必需矿物质(尤其是钙和镁)的严重损失。四环素的主要降解产物是无水-4-表位四环素，具有毒性并在近端肾小管中蓄积，引起范可尼综合征。患者表现为多饮、多尿和脱水的症状，这是由于尿液中过多的水和溶质的流失。

范可尼综合征：Fanconi综合征是遗传性或获得性近端肾小管多功能缺陷的疾病，存在近端肾小管多项转运功能缺陷，包括氨基酸、葡萄糖、钠、钾、钙、磷、碳酸氢钠、尿酸和蛋白质等。https://mp.weixin.qq.com/s/5DuD2PyYEwu27oyd764PmA

正确答案：E