慢性肾盂肾炎为主导病因的肾小管酸中毒骨病：12例成人病例报告

Renal tubular acidosis-induced osteopenia with chronic pyelonephritisas predominant etiologic factor:report of 12 adult cases

本文３５例肾小管酸中毒中１２例（３４％）为骨质减少型。其中９例（７５％）为远曲肾小管酸中毒。该百分点相似于Ｐａｒｆｉｔｔ氏报告，不同于Ｂｉｋｌｅ氏报告。病理骨折达７例（５８％），频度甚高，提示骨病变的严重性和诊治甚迟。病因学上，１２例中６例（５０％）为慢性肾盂肾炎，占主导性。其他类型的肾感染３例（２５％）。以上显示，作为发展中国家的中国，在某些地区，感染性间质性肾炎是骨质减少型肾小管酸中毒的主要原因。本组中７例误诊（５８％），其中５例误诊为原发性甲状旁腺功能亢进，另２例误诊为ＶｉｔＤ缺乏性骨软化症。

In a series of 35 cases of renal tubular acidosis (RTA), 12 had osteopenia(34%). Among the 12 patients with osteopenia RTA, 9 (75%)were diagnosed as having distal RTA(75%), which was similar to the datum reported by Parfitt but different from that by Bikle. Pathological fractures occurred in 7 cases(58%) in high frequency, which showed the great severity of bone disease and lateness for diagnosis and treament. Etiologically, chronic pyelonephritis occurred in 6 cases (50%), predominating among the 12 cases, and other kinds of kidney infections occurred in 3 cases(25%),which showed that infectious interstitial nephritis was the main cause of osteopenia RTA in some districts of China. Misdiagnosed were 7 cases (58%), 5 of whom had primary hyperparathyroidism and 2 of whom had hypovitaminosis D osteomalacia.