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제목	A rare case of young women with hypokalemia nephropathy associated with diabetes melitus and coexisted minimal changes disease
저자	Edi Setiawan
출판정보	2024; 2024(1):
키워드
초록	Introduction Hypokalemia, especially if persistent, can induce a variety of changes in kidney function, impairing tubular transport and possibly inducing chronic tubulointerstitial disease. Chronically low serum potassium levels <3.5 mEq/l have been associated with characteristic histopathological features of nonfatty degeneration of the convoluted tubules, varying from mild cytoplasmic vacuolization to extensive necrosis, interstitial fibrosis and sloughing of tubular cells. Common clinical findings include low urine specific gravity, polyuria, tubular proteinuria, and inactive urinary sediment. Patient concern : We examined a 20-year-old female with intermittent fatigue, persistent hypokalemia, foaming urine for 10 years and newly diagnosed with diabetes melitus. Diagnoses: Based on the results of the clinical data, including electrolytes, fasting glucose test, Hba1c ,and biopsy result. Clinical history was positive for symptoms of orthostatic hypotension and polyuria. Laboratory test showed hypokalemia, hypomagnesemia, hypocalciuria, hiperglycemia, high HBA1c , increase creatinine level and alkalosis metabolic. Urine analysis showed low urine specific gravity, polyuria, hematuria, proteinuria, and inactive urinary sediment. Kidney biopsy showed histological corresponds to glomerulonephritis without the addition of real cells ( minimal changes disease) accompanied by tubulointerstitial nephritis, periglomerular fibrosis, isometric vacuolization with mild to moderate fibrotic interstitium. Intervention : The patient was prescribed potassium chloride and magnesium oral supplements and spironolactone. The patient was also suggested to maintain a high potassium diet. Gliquidon was used to maintain the blood glucose levels. Outcomes: The electrolyte imbalance including hypokalemia, hypomagnesemia and hyperglycemia were improved with a remission of the clinical manifestations. Blood sugar drops following improvement of potassium levels. Conclucions: Diagnostic renal pathology is required, especially patients with recurrent hypokalemia followed by proteinuria. Maximizing therapy of patients with hipokalemia nephropaty comprehensively to reach the target is very important, in cases with potassium 3.8 gr/dl the patient's clinical condition improves, blood sugar is more controlled and able to re-activity.
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