Abstract
IntroductionType 4 renal tubular acidosis is an uncommon clinical manifestation of systemic lupus erythematosus and has been reported to portend a poor prognosis. To the best of our knowledge, this is the first case report which highlights the successful management of a patient with systemic lupus erythematosus complicated by type 4 renal tubular acidosis who did not do poorly.Case presentationA 44-year-old Hispanic woman developed a non-anion gap hyperkalemic metabolic acidosis consistent with type 4 renal tubular acidosis while being treated in the hospital for recently diagnosed systemic lupus erythematosus with multi-organ involvement. She responded well to treatment with corticosteroids, hydroxychloroquine and mycophenolate mofetil. Normal renal function was achieved prior to discharge and remained normal at the patient's one-month follow-up examination.ConclusionThis case increases awareness of an uncommon association between systemic lupus erythematosus and type 4 renal tubular acidosis and suggests a positive impact of early diagnosis and appropriate immunosuppressive treatment on the patient's outcome.
Highlights
Type 4 renal tubular acidosis is an uncommon clinical manifestation of systemic lupus erythematosus and has been reported to portend a poor prognosis
Inability of the kidney either to excrete sufficient net acid or to retain sufficient bicarbonate results in a group of disorders known as renal tubular acidoses (RTAs) [1]
We report a case of a patient with a high SLE disease activity index (SLEDAI) score and type 4 RTA secondary to systemic lupus erythematosus (SLE) who received prompt and appropriate treatment and did not do poorly
Summary
Inability of the kidney either to excrete sufficient net acid or to retain sufficient bicarbonate results in a group of disorders known as renal tubular acidoses (RTAs) [1]. A renal biopsy was done, which revealed diffuse global proliferative and membranous glomerulonephritis This was consistent with lupus nephritis Renal Pathology Society/ International Society of Nephrology 2003 class IV-G(A) and V, moderate activity index 9/24, minimal chronicity index 1/12; minimal tubulointerstitial fibrosis and acute tubular necrosis (Figure 1). She was diagnosed with SLE complicated by a generalized lupus flare, with a SLEDAI score of 29. Complete resolution of the renal impairment (Figures 2 and 3) and type 4 RTA (Figure 4) was achieved She was discharged after 19 days to follow-up in the Rheumatology and Nephrology clinics. Her renal function remained normal at the one-month follow-up clinic visit
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