Atypical clinical presentation of distal renal tubular acidosis: a case report registered in Amazonas, Brazil

ABSTRACT We report an unusual case of a 24-year-old girl with a history of recurrent hypokalemic paralysis episodes and skin lesions on the lower limbs and buttocks, both of which had an acute evolution. In subsequent investigations, the patient also had nephrocalcinosis, nephrolithiasis, hyperchlor...

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Bibliographic Details
Published in:	Brazilian Journal of Nephrology Vol. 42; no. 3; pp. 380 - 383
Main Authors:	Queiroz, Daniel Monteiro, Valenzuela, Rolando Guillermo Vermehren, Marinho, Ana Wanda Guerra Barreto, Santos, Samanta Samara Bicharra dos, Silva, Danielle Ochoa da, Dias, Maykon da Silveira, Cruz, Lorena de Oliveira
Format:	Journal Article
Language:	English
Published:	Sociedade Brasileira de Nefrologia 01-09-2020
Subjects:	Acidosis, Renal Tubular Case Report Hypokalemia Hypokalemic Periodic Paralysis Nephrocalcinosis Nephrolithiasis
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Summary:	ABSTRACT We report an unusual case of a 24-year-old girl with a history of recurrent hypokalemic paralysis episodes and skin lesions on the lower limbs and buttocks, both of which had an acute evolution. In subsequent investigations, the patient also had nephrocalcinosis, nephrolithiasis, hyperchloremic metabolic acidosis and persistent alkaline urinary pH. The findings were consistent with distal renal tubular acidosis as the cause of hypokalemic paralysis. Clinical findings, immunological tests and the result of skin biopsy suggested primary Sjögren's syndrome as an underlying cause. The patient developed azotemia due to obstructive nephrolithiasis. All the features presented in this case are an unusual manifestation of distal renal tubular acidosis; so far, we are not aware of a similar report in the literature. RESUMO Relatamos um caso incomum de uma jovem de 24 anos com história de episódios recorrentes de paralisia hipocalêmica e lesões cutâneas em membros inferiores e nádegas, ambas de evolução aguda. Em investigações subsequentes, verificou-se que a paciente apresentava nefrocalcinose, nefrolitíase, acidose metabólica hiperclorêmica e pH urinário persistentemente alcalino. Os achados foram consistentes com acidose tubular renal distal como causa da paralisia hipocalêmica. Achados clínicos, exames imunológicos e o resultado da biópsia de pele foram compatíveis com a síndrome de Sjögren primária como causa subjacente. A paciente evoluiu com azotemia em decorrência da nefrolitíase obstrutiva. Todas as características apresentadas nesse caso são uma manifestação incomum de acidose tubular renal distal; até o momento, não temos conhecimento de um relato semelhante na literatura.
Bibliography:	CONFLICT OF INTERESTS The authors declare that there is no conflict of interest. The authors contributed to the collection, analysis and interpretation of data, as well as the development of the case report and the approval of the final version. AUTHORS’ CONTRIBUTIONS
ISSN:	0101-2800 2175-8239
DOI:	10.1590/2175-8239-jbn-2019-0224