成人Gitelman综合征的诊治

The diagnosis and treatment of Gitelman syndrome in adults

Gitelman综合征(Gitelman syndrome,GS)是一种常染色体隐性遗传的失盐性肾小管疾病。1966年Gitelman报告了3例家族性低钾、低镁、低氯性碱中毒、低尿钙为特征的疾病,因此而得名。GS的病因是编码位于肾远曲小管的噻嗪类利尿剂敏感的钠氯共同转运体蛋白的基因SLC12A3发生功能缺失突变,从而引起肾脏远曲小管对钠氯重吸收障碍导致低血容量、肾素-血管紧张素-醛固酮系统激活、低血钾和代谢性碱中毒等一系列病理生理改变和临床表现。该文旨在对成人GS的诊断、治疗和随访的流程进行简要综述,从而为临床工作提供参考。

Gitelman syndrome（GS） is an autosomal recessive kidney disorder characterized by low blood levels of potassium and magnesium, decreased excretion of calcium in the urine, and elevated blood pH. The disorder is named for Gitelman, an American nephrologist. He first described it in 1966, after observing a pair of sisters with the disorder. The disorder is caused by inactivating mutations in the SLC12 A3 gene, resulting in improper function of the thiazide-sensitive sodium-chloride co-transporter located in the distal convoluted tubule of the kidney. GS was formerly considered a subset of Bartter syndrome until the distinct genetic and molecular bases of these disorders were identified. GS is usually managed by a liberal salt intake together with oral magnesium and potassium supplements. This review aims to establish an initial framework to enable clinical auditing and thus improve quality control of care.