| 摘要: | 腎臟是人體重要的滲透壓調節器官，通過過濾血液和處理電解質。腎臟疾病，尤其是慢性腎臟病（chronic kidney disease，CKD），是指患者的腎臟在數月或數年內受損，從而導致電解質失衡、蛋白尿，甚至死亡。CKD 和其他腎臟相關疾病與代謝異常、糖尿病、中風、心血管疾病、免疫功能障礙和微生物感染有關。因此，本論文旨在臨床研究CKD與電解質不平衡的關係，以及探討其他腎臟疾病與不同臨床併發症之成因與處置。第一章研究了CKD患者之腎臟對電解質的處理，結果顯示CKD合併糖尿病患者的鎂離子排泄分率 (fractional excretion) 較高，並且隨著CKD的分期而異。第二章探討糖尿病合併末期腎衰竭患者併發非酮性高血糖症與單側舞蹈症的臨床案例，結果顯示經過胰島素控制高血糖、以及適當內科藥物 (clonazepam and risperidone) 治療4週後，這些病症得到控制。第三章研究全身性輕鏈蛋白之類澱粉沉積症與腎臟疾病的關係，結果顯示經過口服melphalan藥物及手術治療後病患之蛋白尿、巨舌、上眼瞼下垂等併發症獲得改善。第四章研究一個肺隱球菌感染案例探討與急性腎損傷和過敏性肺炎的關係，結果顯示病患在經過6個月的抗黴菌治療後這些併發症消失且患者病況恢復。第五章研究了COVID-19疫苗誘發的血栓性血小板減少綜合症與腎上腺靜脈血栓形成的關係，結果顯示在經過靜脈注射免疫球蛋白和類固醇以及新型口服抗凝劑 (普栓達膠囊) 治療後，病患之抗血小板因子4抗體濃度、血小板數量和腎上腺靜脈血栓等併發症均得到改善。這五章的臨床結果提供了證據，證明了鎂離子排泄分率可以作為潛在CKD進展之預測因子，而且透過適當的診斷和藥物治療能改善微生物感染、疫苗或其他疾病患者腎臟相關之併發症。;The kidneys are the essential osmoregulatory organs in humans via filtering blood and processing electrolytes. Kidney disease, particularly chronic kidney disease (CKD), refers to the damage of the kidneys over a period of months or years in patients and thereby leading to electrolyte imbalance, proteinuria, and even death. CKD and other kidney diseases have been reported to associate with metabolic diseases, diabetes mellitus, stroke, cardiovascular disease, immunological dysfunction, and microbial infections. This dissertation was thus designed to clinically study CKD in association with electrolyte imbalances, as well as the associations of other kidney diseases with different clinical complications. Chapter One was to investigate the renal handling of electrolytes in patients with CKD and the results indicated that the fractional excretion of magnesium was higher in CKD patients with diabetes mellitus and varied with the stages of CKD. Chapter Two was to study an association of non-ketotic hyperglycemia and hemichorea-hemiballism in a diabetic patient with end-stage kidney disease, and the results showed these symptoms to be relieved after the 4-week treatment of hyperglycemia with insulin, clonazepam, and risperidone. Chapter Three was to study an association of systemic light-chain amyloidosis with renal disease, and the results indicated that the complications, such as proteinuria, macroglossia, and ptosis, were improved after melphalan treatment and surgical intervention. Chapter Four was to study an association of a patient infected by pulmonary cryptococcosis with acute kidney injury and hypersensitivity pneumonitis, the results indicated that the complications resolved and the patient recovered after the 6-month antifungal therapy. Chapter five was to study an association of COVID-19 vaccine-induced thrombotic thrombocytopenia syndrome with adrenal vein thrombosis. The results showed these complications, including the level of anti-platelet factor 4 antibody, platelet number, and adrenal vein thrombosis were improved after the treatment with intravenous immunoglobulin, methylprednisolone, and oral anticoagulant (dabigatran). These clinical results of the five chapters provide evidence for the potential use of fractional excretion of magnesium as a predictor of CKD progression, as well as using appropriate medical therapy for the improvement of renal complications in patients when they have a microbial infection, vaccination, or other clinical diseases. |
