renal magnesium loss
Introduction
Introduction to renal magnesium loss Renal magnesium loss is a rare disease of renal tubular dysfunction. There are many diseases that cause renal magnesium loss. It can be divided into primary and secondary, mostly secondary. basic knowledge The proportion of illness: 0.0035% Susceptible people: no special people Mode of infection: non-infectious Complications: hypotension, arrhythmia
Cause
Cause of renal magnesium loss
(1) Causes of the disease
1. Primary renal magnesium loss: renal tubular dysfunction due to autosomal recessive inheritance, type 1 is simple renal tubular reabsorption magnesium dysfunction, with amino acid urinary type, and another type is renal tubular reabsorption magnesium Dysfunction is associated with abnormal potassium transport, also known as potassium transport disorder.
2. Secondary renal magnesium loss: caused by the disease of the kidney itself, common causes are renal tubular acidosis, Bartter syndrome, renal failure, kidney transplantation, and extra-renal diseases such as primary aldosteronism, Hypercalcemia, hyperthyroidism, chronic alcoholism and certain drugs, such as calcitonin, growth hormone, diuretics, cardiac glycosides, aminoglycoside antibiotics, etc., can increase urinary magnesium.
(two) pathogenesis
The disease is caused by a variety of causes, so the pathogenesis has not yet been elucidated. It is generally believed that the genetically related renal magnesium loss is a renal tubular dysfunction caused by multiple gene defects, and the renal magnesium loss caused by secondary causes. The pathogenesis may vary depending on the underlying disease, such as renal magnesium loss caused by hyperaldosteronism, which may be caused by aldosterone by inhibiting reabsorption or by volume expansion, resulting in an increase in sodium and magnesium in the urine, sodium, magnesium. The amount of the distal tubules is increased, and in the distal tubules, since aldosterone can promote the reabsorption of sodium, it has no effect on the reabsorption of magnesium, so the amount of uranium is increased.
Prevention
Renal magnesium deficiency prevention
Caused by hereditary factors, there is no effective measures to prevent it; secondary renal magnesium loss is mainly to actively treat the primary disease and regularly detect blood magnesium, and found that the condition is promptly given symptomatic treatment to prevent serious complications.
Complication
Renal magnesium deficiency complications Complications, hypotension, arrhythmia
Can be complicated by multiple systemic symptoms, such as consciousness, directional disorder, hallucinations, neuromuscular stimulation, numbness of the limbs, tremors, hypotension, arrhythmia and cardiac arrest.
Symptom
Renal magnesium loss symptoms common symptoms gait instability hypocalcemia tremor vertigo vomiting hallucinations tremor hypotension stroke diabetes
The main clinical manifestations of this disease are hypomagnesemia, increased urinary magnesium excretion, may be associated with amino aciduria, diabetes, renal potassium loss and calcium loss, neuromuscular symptoms due to hypomagnesemia, patients may be expressed as muscle fibrillation, Trembling, hand and foot spasm, wrist and handcuffs, convulsions, facial nerve slamming test and beam arm compression test positive, gait instability, mental abnormalities, but also nausea, vomiting, loss of appetite, weakness, dizziness, etc., blood phosphorus reduction, ECG shows that the T wave is low or inverted, and the secondary person often has the performance of the primary disease. Because magnesium is the second important cation in the cell, it involves the activation of the enzyme system, which plays a key role in the metabolism and phosphorylation of the body. Lack of systemic dysfunction, blood magnesium extremely reduced to below 10mg / L, can appear central nervous system manifestations, such as consciousness, directional disorder, hallucinations, neuromuscular stimulation, limb numbness, tremor, etc., gastrointestinal manifestations Loss of appetite, diarrhea, abdominal pain; human cardiovascular system can have ventricular arrhythmia, hypotension, and even cardiac arrest.
Examine
Renal magnesium loss test
1. Urine examination: urinary magnesium increased significantly > 4mmol / L (less than 12mg / 24h in the urine for magnesium deficiency) with hypokalemia, may have increased urinary potassium, and amino acid urine and diabetes.
2. Blood examination: blood magnesium decreased, blood calcium decreased (PTH secretion and dysfunction), blood potassium decreased, renal tubular dysfunction, mild metabolic alkalosis, plasma renin activity increased, but aldosterone content was normal, Glomerular filtration rate is normal.
3. Conventional imaging and B-ultrasound, electrocardiogram examination.
4. Kidney biopsy can help to diagnose the primary disease.
Diagnosis
Diagnostic differential diagnosis of renal magnesium
diagnosis
By understanding the medical history, the primary often has a family history, and the secondary often has inherent disease manifestations. According to typical clinical manifestations, that is, increased urinary magnesium, accompanied by amino aciduria or diabetes, hypomagnesemia or hypokalemia, low For laboratory tests such as calciumemia, the diagnosis of this disease can be considered.
Differential diagnosis
Differential diagnosis should exclude intestinal absorption dysfunction, hyperparathyroidism, primary aldosteronism, hyperthyroidism, Bartter syndrome and hypomagnesemia caused by the use of aminoglycoside antibiotics or cisplatin, Hypokalemia and the like.
