단일 신장 환자에서 급성 폐색성 요관결석으로 촉발된 메트포민 젖산산증
Metformin-Associated Lactic Acidosis Precipitated by an Acute Obstructing Ureteral Stone in a Patient with a Single Functioning Kidney
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
A 35-year-old male with type-2 diabetes mellitus and a history of insulin and metformin (2,000 mg/day) use presented to the emergency department (ED) with generalized weakness. Abdominal computed tomography (CT) performed 3 months prior to presentation showed a severely atrophic right kidney and a few tiny stones in the left kidney, with a serum level of creatinine of 1.14 mg/dL. At the ED, the patient’s blood pressure was 153/89 mmHg. Workup revealed acute kidney injury (creatinine, 11.97 mg/dL), high-anion-gap metabolic acidosis (pH, 6.93), and a blood lactic acid level > 15 mmol/L. Based on the medication history, the patient was diagnosed with metformin-associated lactic acidosis. CT showed a left distal ureteral stone, measuring 6 mm in size, which resulted in hydroureteronephrosis. The patient was initially treated with continuous renal replacement therapy. Subsequently, left percutaneous nephrostomy was performed, which led to the return of the creatinine level to baseline, with complete resolution of lactic acidosis.
Abstract
A 35-year-old male with type-2 diabetes mellitus and a history of insulin and metformin (2,000 mg/day) use presented to the emergency department (ED) with generalized weakness. Abdominal computed tomography (CT) performed 3 months prior to presentation showed a severely atrophic right kidney and a few tiny stones in the left kidney, with a serum level of creatinine of 1.14 mg/dL. At the ED, the patient’s blood pressure was 153/89 mmHg. Workup revealed acute kidney injury (creatinine, 11.97 mg/dL), high-anion-gap metabolic acidosis (pH, 6.93), and a blood lactic acid level > 15 mmol/L. Based on the medication history, the patient was diagnosed with metformin-associated lactic acidosis. CT showed a left distal ureteral stone, measuring 6 mm in size, which resulted in hydroureteronephrosis. The patient was initially treated with continuous renal replacement therapy. Subsequently, left percutaneous nephrostomy was performed, which led to the return of the creatinine level to baseline, with complete resolution of lactic acidosis.
참고문헌 (10)
- Kaneto H, "Multifaceted mechanisms of action of metformin which have been unraveled one after another in the long history", Int J Mol Sci, 22, pp.2596~ (2021)
- Salvatore T, "Metformin lactic acidosis : should we still be afraid?", Diabetes Res Clin Pract, 157, pp.107879~ (2019)
- Di Mauro S, "Metformin : when should we fear lactic acidosis?", Int J Mol Sci, 23, pp.8320~ (2022)
- Inker LA, "New creatinine-and cystatin C-based equations to estimate GFR without race", N Engl J Med, 385, pp.1737~1749 (2021)
- Visconti L, "Metformin-related lactic acidosis : is it a myth or an underestimated reality?", Ren Fail, 38, pp.1560~1565 (2016)
- Seheult J, "Lactic acidosis : an update", Clin Chem Lab Med, 55, pp.322~333 (2017)
- Isaka Y, "Guideline on the use of iodinated contrast media in patients with kidney disease 2018", Clin Exp Nephrol, 24, pp.1~44 (2020)
- Rashid U, "Bilateral ureteral obstruction causing acute kidney injury and resultant metformin toxicity", Cureus, 13, pp.e19635~ (2021)
- Boxma RPJ, "A rare combination of bilateral obstructing ureteral stones, acute kidney injury and metformin-associated lactic acidosis : a case report", Int J Crit Care Emerg Med, 7, pp.114~ (2021)
- Gök MG, "Metformin associated lactic acidosis in a renal transplant patient", Cukurova Med J, 42, pp.366~368 (2017)