摘要
患者男性,29岁,因“间断骨关节痛、乏力10个月,多尿、尿中泡沫增多7个月”于2017年11月入院。患者主诉于2017年1月出现左肩、左上臂、双侧肋骨及右胫骨酸痛,双肩关节、双髋压痛,双下肢乏力及活动耐量下降,表现为步履蹒跚、行走费力。2017年4月出现尿量增加(较前增加约1倍),每天约2000 mL以上,夜尿增多、尿中泡沫增多、排尿不畅,进水量大致同前。既往10年前诊断慢性乙型病毒性肝炎,5年前开始持续口服阿德福韦酯10 mg/d+拉米夫定100 mg/d抗病毒治疗,多次复查肝生化检查正常,无乙型病毒性肝炎活动,无其他既往病史。
A young male patient with a clear diagnosis of chronic hepatitis B,had taken long-term adefovir dipivoxil and lamivudine antiviral therapy.Osteomalacia related symptoms,such as bone pain and walking difficulties appeared 10 months ago.Renal damage related symptoms,such as urine volume change and increased urinary foam appeared 7 months ago.The examination showed signs of osteomalacia after admission,such as duck step,osteoarticular tenderness,thoracic and pelvic compression sign positive.Relevant examinations showed that hypophosphatemic osteomalacia related signs,such as hypophosphatemia,normal blood calcium,elevated blood alkaline phosphatase,no significant decline in active vitamin D3 and intact parathyroid hormone(iPTH).In bone mineral density test,bone fracture line could be noted.Bone scan suggested multiple metabolic lesions.At the same time,there were Fanconi syndrome related performances,such as elevated serum creatinine,decreased blood uric acid,urine glucose positive,elevated urinary and uric acid,urinary protein positive with mainly small molecule proteins,increased renal tubular damage indicators,and the clearance test suggested a decrease in renal tubular reabsorption of phosphorus.Kidney stones could be seen in urinary ultrasound.Therefore,combined with the patient’s clinical manifestations,past history and examinations,we definitely considered his diagnosis was adefovir dipivoxil related renal injury.Adefovir has been widely used for the treatment of chronic hepatitis B.Some studies confirmed that the nephrotoxicity of adefovir,including Fanconi syndrome and hypophosphatemic osteomalacia,was dose-dependent.A daily high-dose of 60-120 mg/d adefovir was concluded in the treatment of human immunodeficiency virus(HIV)infection,inducing nearly 1/2 patients of renal injury.A daily moderate-dose of 30 mg/d adefovir was used for patients in chronic hepatitis B,with nearly 1/3 patients of renal injury.Long-term low-dose adefovir(10 mg/d)used for chronic hepatitis B patients was found to be responsible fo
作者
孙雯
李昂
张俊清
袁振芳
SUN Wen;LI Ang;ZHANG Jun-qing;YUAN Zhen-fang(Department of Pulmonary and Critical Care Medicine,Peking University First Hospital,Beijing 100034,China;Department of Endocrinology,Peking University First Hospital,Beijing 100034,China)
出处
《北京大学学报（医学版）》
CAS
CSCD
北大核心
2020年第5期975-979,共5页
Journal of Peking University:Health Sciences
