臭素酸塩による急性腎不全に合併した末梢神経障害の1例

A BIOPSY CASE OF NEUROPATHY ACCOMPANIED BY ACUTE RENAL INSUFFICIENCY DUE TO BROMATE

I．はじめに

　ここに報告しようとしている症例は，臭素酸化合物服用により急性腎不全を発現し，その経過中に末梢神経障害を合併したものであり，その末梢神経を生検する機会が得られた。

　臭素酸化合物の中毒症はCarratala^6）の報告以来，外国では^6,8,10,14）主に幼児の誤飲が原因で，本邦では^{9,11,13，18,19）}自殺の目的で服用した症例が多数報告されている。障害は主に腎臓，消化器，造血器および中枢神経系が侵されているが，末梢神経障害についての報告はない。

A case of 21 year old male with neuropathy caused by renal insufficiency was present. He had taken bromate (mixed powder of potassium bromateand sodium bromate) for the purpose of suicide and suffered from acute renal insuffidiency and hard of hearing. Renal dysfunction improved gradually by peritoneal dialysis and hemodialysis. However, on the 32th day after the onset, burning pain appeared in the bilateral feets. Following this, he began to complain of the disturbances of superficial and deep sensory below the ankle jerks and the weakness of his toes. Considerring the clinical features, we supposed that the disturbance of the peripheral nerve was caused by uremia due to taking bromate. N. suralis was biopsied on the 80th day after the onset and examined electron microscopically. Electroscopical findings was asfollows. Degeneration of the Schwann cells and irregularity or destruction of the myelin sheaths were observed. The axoplasm of the myelinated nerve fiber were relatively preserved as compared with the changes of the myelin sheaths. In the unmyelinated nerve fibers, cavity formations were observed. The findings of regeneration were not observed. From the electron microscopical findings, we speculate that the changes of the Schwann cells and the myelin sheaths are primary resulting from the disturbance of the metabolism of the Schwann cells. We speculate that anemia and hypoproteine-mia caused by bromate disturbed regeneration.