Renal tubular acidosis type IV as a complication of lupus nephritis

Lupus
C Sánchez-MarcosG Espinosa

Abstract

Renal tubular acidosis (RTA) is a rare complication of renal involvement of systemic lupus erythematosus (SLE). We describe a 24-year-old male with type IV lupus nephropathy as a presenting manifestation of SLE. He presented with improvement of renal function following induction therapy with three pulses of methylprednisolone and 500 mg biweekly pulses of cyclophosphamide. However, a week after the first pulse of cyclophosphamide, the patient presented with a significant increase in legs edema and severe hyperkalemia. Type IV RTA associated with hyporeninemic hypoaldosteronism was suspected in the presence of metabolic acidosis with a normal anion gap, severe hyperkalemia without worsening renal function, and urinary pH of 5. RTA was confirmed with a transtubular potassium concentration gradient of 2 and low levels of plasma aldosterone, renin, angiotensin II, and cortisol. Intravenous bicarbonate, high-dose furosemide, and fludrocortisone were administered with normalization of potassium levels and renal function.

References

Feb 15, 2011·International Journal of Clinical Practice·P Reddy
Aug 2, 2012·Annals of the Rheumatic Diseases·George K BertsiasUNKNOWN European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association
Nov 6, 2013·Autoimmunity Reviews·Guillermo Ruiz-IrastorzaMunther Khamashta
Apr 1, 2014·Rheumatology International·Tim BothPaul L A van Daele
Jun 20, 2014·Comprehensive Physiology·Steven B Magill

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Citations

Feb 13, 2018·Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology·Hans Raj PahadiyaPayal Bargujar
Mar 5, 2020·Clinical Case Reports·Prashanth RawlaMostafa Ebraheem Morra
Mar 14, 2020·Rheumatology International·Döndü Üsküdar CansuCengiz Korkmaz
Dec 29, 2020·Advances in Therapy·Biff F PalmerDeborah J Clegg

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Methods Mentioned

BETA
biopsy

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