Skin pigmentation is bronze

Introduction Loss of salt nephritis has typical clinical manifestations of polyuria and nocturia, skin pigmentation is bronze, etc., salt-losing nephritis, also known as Thorn syndrome, is currently considered to be a group of features characterized by severe renal salt loss. A special type of kidney disease.

Cause

(1) Causes of the disease

The disease is a clinically rare syndrome of chronic kidney disease. Common causes are:

1. Chronic interstitial nephritis, chronic pyelonephritis.

2. Renal medullary cystic lesions, such as polycystic kidney disease.

3. Kidney tuberculosis, renal calcification.

4. bilateral renal hypoplasia.

5. Obstructive nephropathy.

(two) pathogenesis

Renal tubular epithelial cell damage caused by renal interstitial disease makes it less responsive to aldosterone, renal tubular reabsorption of sodium chloride is reduced, and a large amount of sodium chloride is excreted from the urine, resulting in hyponatremia. Its particularity is that the reabsorption of sodium chloride by renal tubular loss is far more serious than that of glomerular function. In severe cases, a large number of nephrons may be damaged, and the survivors are subject to excessive loading of solute in the plasma, causing osmotic diuretic effects, i.e., excessive loss of salt and moisture.

an examination

Related inspection

Renal ultrasonography renal static imaging renal dynamic imaging

1. Mostly adult males, especially young people.

2. There are symptoms similar to Addison disease, 50% of patients have polyuria and nocturia, skin pigmentation is bronze, evenly distributed, but buccal mucosal pigmentation is less common, which is different from Addison disease. Acute exacerbation is often weak, loss of appetite, nausea and vomiting, physical examination found that weight loss, weak pulse, low blood pressure, prone to orthostatic hypotension, collapse and syncope. Dehydration and tendon, severe mental confusion, paralysis, coma, uremia and acidosis.

3. Have a history of chronic kidney disease.

4. Ingestion of large amounts of salt (10 ~ 20g / d) can alleviate symptoms. 30% of patients have a history of gastritis and long-term use of large amounts of alkaline drugs.

5. Deoxycorticosterone treatment was ineffective, adrenal cortical function test was normal, and urinary aldosterone was increased.

1. There are typical clinical manifestations of polyuria and nocturia, skin pigmentation is bronze, acute exacerbation is often weak, loss of appetite, nausea and vomiting, weight loss, weak pulse, low blood pressure, prone to orthostatic hypotension, Deficiency and syncope. Dehydration, tendon, severe mental confusion, paralysis, coma and uremia acidosis.

2. Laboratory tests have blood sodium, blood chlorine decreased, blood potassium increased (occasionally reduced), azotemia and metabolic acidosis changes.

3. In the case of ingestion of 10 g/d of salt, the normal sodium balance could not be maintained.

4. Deoxycorticosterone treatment is ineffective.

5. Adrenal cortical function is normal and urinary aldosterone content is increased.

A diagnosis can be made based on the above.

Differential diagnosis

Pigmentation and hypopigmentation: The mechanism of pigment abnormalities is more complicated. Some pigmented skin diseases are caused by genetic factors; others are caused by secondary factors; others are not clear.

Skin atrophy and hyperpigmentation: Skin atrophy refers to the formation of a cord-like atrophy due to obstruction, pregnancy, edema and other reasons. Pigmentation is an endogenous pigment such as hemosiderin, lipofuscin, melanin, and bilirubin in normal humans. Carbon dust, coal dust, and tattoo pigments sometimes enter the body. Under pathological conditions, some of the above pigments will increase and accumulate inside and outside the cell. It is called pigmentation.

Reticular pigmentation plaques: dermatopathia pigmentosa reticularis (DPR) is a rare disease that is clinically characterized by reticular pigmentation, non-scarring alopecia and malnutrition.

Fine mesh to patchy pigmentation: pigmentation spots are fine mesh to patchy, initially reddish. After turning to grayish gray to dark brown, it is often found in the exposed parts of the cheeks, neck and back, especially around the eyelids and the ankles.

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