肾内科

订阅

MedSci主页 / 所有栏目 / 肾内科

NEJM：尿毒症霜-病例报道

2018-08-16 xing.T MedSci原创

尿毒症霜终末期肾病尿素
关注

尿毒症霜与严重的氮质血症有关，并且是由汗液蒸发后皮肤上尿素结晶所致。在血液透析广泛可用的地区，这种症状十分罕见。

患者为一名39岁的男子，患有终末期肾病，因急性缺氧、恶心、呕吐和少尿而被送往急诊就诊。五个月前，他已经停止参加他的常规血液透析；他报告说他认为不需要这些血液透析，因为他继续有尿液排出。



体检时，他的血压为167/80 mmHg。昏昏欲睡，语速减慢，双腿水肿，他的呼出气体有一股尿液气味。皮肤有弥漫的结晶白色沉积物，主要分布在他的脸部（如图A）、腹部（如图B）和手臂。实验室检查显示血液尿素氮水平为231毫克/分升（82.5mmol/L），肌酐水平为20.0毫克/分升（1770 umol/L），钠水平为125 mmol/L，钾水平为7.7mmol/L。患者L立刻接受了血液透析。

尿毒症霜与严重的氮质血症有关，并且是由汗液蒸发后皮肤上尿素结晶所致。在血液透析广泛可用的地区，这种症状十分罕见。

该患者恢复正常的血液透析治疗后，嗜睡症状减轻，并且在就诊后2周尿毒症霜完全消退。

原始出处：

Joana M. Martins,et al. Uremic Frost in End-Stage Renal Disease.N Engl J Med 2018; https://www.nejm.org/doi/full/10.1056/NEJMicm1716367

本文系梅斯医学（MedSci）原创编译整理，转载需授权！

评论区 (5)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=339470, encodeId=b6b73394e07d, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Sun Aug 19 07:35:37 CST 2018, time=2018-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=339308, encodeId=6ff5339308e4, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=110, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Sat Aug 18 10:40:42 CST 2018, time=2018-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1290409, encodeId=49dc12904091c, content=<a href='/topic/show?id=facb4e432e4' target=_blank style='color:#2F92EE;'>#尿毒症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47432, encryptionId=facb4e432e4, topicName=尿毒症)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=74c2229, createdName=tcm99hq, createdTime=Sat Aug 18 07:11:00 CST 2018, time=2018-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=339083, encodeId=178533908396, content=学了, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Fri Aug 17 06:38:28 CST 2018, time=2018-08-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=339002, encodeId=a94e33900287, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=118, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Thu Aug 16 18:26:34 CST 2018, time=2018-08-16, status=1, ipAttribution=)]
    2018-08-19 哈哈869

    学习了

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=339470, encodeId=b6b73394e07d, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Sun Aug 19 07:35:37 CST 2018, time=2018-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=339308, encodeId=6ff5339308e4, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=110, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Sat Aug 18 10:40:42 CST 2018, time=2018-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1290409, encodeId=49dc12904091c, content=<a href='/topic/show?id=facb4e432e4' target=_blank style='color:#2F92EE;'>#尿毒症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47432, encryptionId=facb4e432e4, topicName=尿毒症)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=74c2229, createdName=tcm99hq, createdTime=Sat Aug 18 07:11:00 CST 2018, time=2018-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=339083, encodeId=178533908396, content=学了, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Fri Aug 17 06:38:28 CST 2018, time=2018-08-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=339002, encodeId=a94e33900287, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=118, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Thu Aug 16 18:26:34 CST 2018, time=2018-08-16, status=1, ipAttribution=)]
    2018-08-18 哈哈869

    学习了

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=339470, encodeId=b6b73394e07d, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Sun Aug 19 07:35:37 CST 2018, time=2018-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=339308, encodeId=6ff5339308e4, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=110, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Sat Aug 18 10:40:42 CST 2018, time=2018-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1290409, encodeId=49dc12904091c, content=<a href='/topic/show?id=facb4e432e4' target=_blank style='color:#2F92EE;'>#尿毒症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47432, encryptionId=facb4e432e4, topicName=尿毒症)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=74c2229, createdName=tcm99hq, createdTime=Sat Aug 18 07:11:00 CST 2018, time=2018-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=339083, encodeId=178533908396, content=学了, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Fri Aug 17 06:38:28 CST 2018, time=2018-08-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=339002, encodeId=a94e33900287, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=118, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Thu Aug 16 18:26:34 CST 2018, time=2018-08-16, status=1, ipAttribution=)]
    2018-08-18 tcm99hq

    #尿毒症#

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=339470, encodeId=b6b73394e07d, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Sun Aug 19 07:35:37 CST 2018, time=2018-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=339308, encodeId=6ff5339308e4, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=110, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Sat Aug 18 10:40:42 CST 2018, time=2018-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1290409, encodeId=49dc12904091c, content=<a href='/topic/show?id=facb4e432e4' target=_blank style='color:#2F92EE;'>#尿毒症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47432, encryptionId=facb4e432e4, topicName=尿毒症)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=74c2229, createdName=tcm99hq, createdTime=Sat Aug 18 07:11:00 CST 2018, time=2018-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=339083, encodeId=178533908396, content=学了, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Fri Aug 17 06:38:28 CST 2018, time=2018-08-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=339002, encodeId=a94e33900287, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=118, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Thu Aug 16 18:26:34 CST 2018, time=2018-08-16, status=1, ipAttribution=)]
    2018-08-17 哈哈869

    学了

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=339470, encodeId=b6b73394e07d, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Sun Aug 19 07:35:37 CST 2018, time=2018-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=339308, encodeId=6ff5339308e4, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=110, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Sat Aug 18 10:40:42 CST 2018, time=2018-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1290409, encodeId=49dc12904091c, content=<a href='/topic/show?id=facb4e432e4' target=_blank style='color:#2F92EE;'>#尿毒症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47432, encryptionId=facb4e432e4, topicName=尿毒症)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=74c2229, createdName=tcm99hq, createdTime=Sat Aug 18 07:11:00 CST 2018, time=2018-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=339083, encodeId=178533908396, content=学了, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Fri Aug 17 06:38:28 CST 2018, time=2018-08-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=339002, encodeId=a94e33900287, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=118, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Thu Aug 16 18:26:34 CST 2018, time=2018-08-16, status=1, ipAttribution=)]
    2018-08-16 哈哈869

    学习了

    0