A case of recurrent renal failure associated with metabolic alkalosis induced by protracted vomiting.
We describe a case of recurrent deterioration of renal function in a 54-year-old man who was found to have metabolic alkalosis, with a maximum PaCO(2) of 73.9 mmHg and a bicarbonate concentration of 55.3 mmol/l. He had a gradual exacerbation of nausea and vomiting due to atrophic gastritis, with a scarred, deformed pyloric part of the stomach and a duodenal bulb secondary to chronic peptic ulcer. His metabolic alkalosis and deteriorated renal function were corrected by intravenous saline with or without potassium chloride. However, his recovered creatinine clearance was at most 60 l/day (41.6 ml/min). A renal biopsy revealed cellular infiltration of mononuclear cells and atrophic change in the tubulointerstitium, suggesting chronic interstitial nephritis. Latent renal insufficiency and dehydration induced by protracted vomiting may easily induce a rapid and recurrent deterioration of renal function, and control of vomiting seemed to be the cardinal measure. Initially, his nausea and vomiting seemed to be successfully controlled by medication, however, they later became persistent and surgical correction of the stomach was carried out. Postoperative recovery was smooth, and the patient's vomiting and recurrent deterioration of renal function finally settled.
Akimoto
Tetsu
T
Division of Nephrology, Department of Internal Medicine, Jichi Medical School, 3311-1 Yakushiji, Minamikawachi-machi, Tochigi 329-0498, Japan. tetsu-a@jichi.ac.jp
Saito
Osamu
O
Kotoda
Atsushi
A
Nishino
Katsuhiko
K
Umino
Tetsuo
T
Muto
Shigeaki
S
Kusano
Eiji
E
D000136:Acid-Base Equilibrium; D000471:Alkalosis / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000150:complications / Q000601:surgery; D012008:Recurrence; D051437:Renal Insufficiency / Q000209:etiology*; D013270:Stomach / Q000601:surgery; D014839:Vomiting / Q000150:complications*