汞中毒相关肾损害1例并文献复习

A case report and literature review of renal injury induced by mercury intoxication

目的总结汞中毒相关肾损害的病因、临床特点、治疗及预后。方法报道海南省人民医院肾病风湿科收治汞中毒相关肾损害1例,并查阅我国1998～2012年有关汞中毒相关肾损害报告文献16篇,共98例患者,对其临床表现、病理分型、治疗方法、预后等进行分析。结果 98例患者致病因素主要为职业性接触、生活性接触或医源性接触含汞物质所致,临床表现为水肿、蛋白尿、肾病综合征等,常见肾脏病理类型为膜性肾病(68.2%)、微小病变肾病(22.7%),治疗以驱汞及激素治疗为主。经积极治疗,临床有效缓解率约为95.9%(共94例),总体疗效好。结论汞中毒性肾损害主要由汞接触引起,以肾病综合征为主要临床表现,其病理为膜性肾病多见,驱汞治疗为主要措施,积极治疗预后良好。

Objective To sum up the pathogenesis,clinical feature,treatment and prognosis of renal injury induced by mercury intoxication.Methods A new renal injury case induced by mercury intoxication in Hainan Provincial People’s Hospital was reported and the literature of 16 articles concerning 98 renal injury cases induced by mercury intoxication from 1998 to 2012 in China were collected and reviewed.The clinical manifestations,pathological types,treatments and prognoses on the 98 cases are respectively analyzed.Results The 98 cases were mainly caused by either occupational exposure,life exposure,or iatrogenic exposure to mercury-containing substances.Their most common clinical symptoms included edema,proteinuria,and nephrotic syndrome,etc,with major pathological types of membranous nephropathy（68.2%） and minimal change nephropathy（22.7%）.Major treatments included chelation therapy and hormone therapy.Ninety four cases gained effective remission,with a remission rate of 95.9%.Conclusions Renal injury induced by mercury intoxication can mainly be ascribed to mercury exposure,with major manifestations of nephrotic syndrome Membranous nephropathy is relatively more common than other pathological types.A proper chelation therapy will lead to a satisfactory prognosis.