Renal tubular acidosis type IV as a complication of lupus nephritis

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 p...

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Bibliographic Details
Published in:Lupus 2016-03, Vol.25 (3), p.307-309
Main Authors: Sánchez-Marcos, C, Hoffman, V, Prieto-González, S, Hernández-Rodríguez, J, Espinosa, G
Format: Article
Language:English
Subjects:
Acidosis - etiology
Anti-Inflammatory Agents - administration & dosage
Bicarbonates - administration & dosage
Drug Therapy, Combination
Edema - etiology
Glucocorticoids - administration & dosage
Humans
Hyperkalemia - etiology
Hypoaldosteronism - diagnosis
Hypoaldosteronism - drug therapy
Hypoaldosteronism - etiology
Immunosuppressive Agents - administration & dosage
Lupus Erythematosus, Systemic - complications
Lupus Erythematosus, Systemic - diagnosis
Lupus Erythematosus, Systemic - drug therapy
Lupus Nephritis - diagnosis
Lupus Nephritis - drug therapy
Lupus Nephritis - etiology
Male
Pulse Therapy, Drug
Sodium Potassium Chloride Symporter Inhibitors - administration & dosage
Treatment Outcome
Young Adult
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Summary: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.
ISSN:0961-2033
1477-0962
DOI:10.1177/0961203315603143