2015年 · 第31卷第05期

Chronic kidney disease – mineral and bone abnormalities (CKD-MBD) is one of the most common complications in patients with chronic renal failure. Calcium and phosphorus metabolism disorders are independent risk factors affecting the quality of life and survival rate of patients with end-stage renal failure. For every 0.3 mmol/L increase in blood phosphorus, the risk of death increases by 6%^[1]。 Therefore, correcting chronic kidney disease-mineral and bone abnormalities is of great significance to prolong the survival rate and improve the quality of life of patients with stage 5 CKD. At present, there are few studies on the effect of hypocalcium peritoneal dialysis on CKD-MBD and the difference of bone metabolism between diabetic nephropathy (DN) and non-DN peritoneal dialysis (peritoneal dialysis) patients.

A 20-year-old female was admitted to the hospital for "intermittent abdominal pain with fatigue for more than 1 year, recurring for 10 days". The patient was admitted to the local hospital on June 10, 2013 due to paroxysmal lower abdominal pain after a cold, accompanied by abdominal distension, constipation, nausea and vomiting. During this period, the urine was pale red, the limbs were weak, and I gradually felt irritable. I had twice convulsions. Urinary bilirubin 1+, serum potassium 3.00-3.54 mmol/L, serum sodium 113-131 mmol/L, and serum chlorine 83-103 mmol/L were all low; Alanine aminotransferase was 70-85 U/L and aspartate aminotransferase was 120-161 U/L, all of which were increased; creatinine 55 μ mol/L; Abdominal CT scan showed colonic gas accumulation and gas-liquid level, but skull CT showed no abnormality. Diagnosis of "intestinal obstruction?", sedation, potassium supplementation, sodium supplementation and other treatment, the symptoms improved and discharged. Since then, the above symptoms have recurred, appearing once every 4 to 5 months, which is more frequent than after cold and before menstruation, and can be relieved after rehydration treatment. Pale red urine persisted, and MRI of the head showed multiple patchy abnormal signals in bilateral cerebral hemispheric cortex, and lumbar puncture showed normal cerebrospinal fluid. On August 15, 2014, due to anorexia and abdominal distension after traveling, on August 24, potassium 3.93 mmol/L, sodium 124.4 mmol/L, chlorine 89.8 mmol/L and creatinine 87.0 μ mol/L were checked in the local hospital. Thyroid function, autoantibody spectrum, complement, immunoglobulin, vasculitis, syphilis, HIV, abdominal color ultrasound and chest X-ray were all normal. The diagnosis was "low sodium and low chlorine to be examined", and there was no obvious improvement after treatment, so he was referred to our hospital.

With the changes of people's diet structure and lifestyle, diabetes mellitus (DM) has become a major disease that endangers human health. In 2013, the number of diabetes patients in China was 98.4 million, ranking first in the world^[1]。 Diabetes is prone to many complications, among which diabetic nephropathy (DN) is a common microvascular disease in diabetes. At present, there is a lack of effective treatment methods, and it is the leading cause of end-stage renal disease (ESRD) in developed countries. The pathogenesis of DN is complex. In recent years, the importance of inflammation in its occurrence and development has begun to attract attention^[2]While Wnt members of the Wingless-Int family and their receptors are extensively involved in inflammation-related signaling pathways. Scholars believe that Wnt5a may be involved in the pathogenesis of DN, and drugs that inhibit or adjust Wnt pathway may bring new ideas for the prevention and treatment of diabetes and diabetic nephropathy. In this paper, the research progress of Wnt signaling pathway affecting the development of diabetes mellitus and diabetic nephropathy in recent years will be reviewed.