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- Title
Recurrent bilateral nephrolithiasis as a presentation for distal renal tubular acidosis.
- Authors
Mittal, Madhukar; Jha, Praveen; Jain, Neha; Goel, Apul
- Abstract
Introduction: Renal tubular acidosis (RTA) has various clinical presentations including short stature, metabolic bone disease, and nephrolithiasis. Objective: We report three cases of distal RTA (dRTA) presenting at the urology department with bilateral nephrolithiasis who were referred to us for endocrine and metabolic evaluation. Materials and Methods: The patients with recurrent nephrolithiasis were referred to us from the urology department. Serum electrolytes, serum calcium, phosphorus, magnesium, 25-hydroxyvitamin D [25(OH) D], and parathyroid hormone (PTH) were measured. Urinary tract infection was ruled out or treated before testing for urinary pH and 24-hour urinary metabolic profile (for citrate, oxalate, magnesium, and calcium). Results: Patient 1was a 48-year-old female with a history of two admissions for hypokalemic periodic quadriparesis in 2008 and in 2011. Her ultrasonography (USG) of the abdomen revealed bilateral nephrocalcinosis along with bilateral nephrolithiasis. She was also found to have primary hypothyroidism. Patient 2 was a 40-year-old male who presented at the urology department with complaints of hematuria and reduced urinary stream. On ultrasound, the patient had bilateral nephrolithiasis with nephrocalcinosis and anemia with a hemoglobin level of 8.5 g%. The third patient was younger (26-year-old male), but had similar complaints along with dysuria. All these patients had normal serum creatinine levels. Bicarbonate treatment was given in dosages of 1-3 meq/kg/day (soda mint tablets and bicarbonate-containing syrup) along with potassium chloride. Vitamin D was supplemented in therapeutic doses. Patient 1 was given levothyroxine 62.5 μg/day after which her thyroid functions remained stable and within normal range on follow-up. All three patients have been on regular follow-up in our endocrine clinic and their serum potassium levels are normal. Patient 1(female) discontinued treatment for approximately two months during the course of the treatment. However, with regular bicarbonate treatment, the metabolic acidosis resolved and no progression in nephrocalcinosis was seen [Tables 1 and 2]. Conclusion: dRTA is an important cause for recurrent nephrolithiasis. Hypokalemic periodic paralysis may be associated with dRTA. As patients with nephrolithiasis initially report to urologists or surgeons, a co-ordinated approach involving endocrine and metabolic evaluation is necessary to prevent recurrent stone formation and a consequent need for future surgical intervention.
- Subjects
ACIDOSIS; KIDNEY tubules; KIDNEY stones; SYMPTOMS; DIAGNOSTIC ultrasonic imaging; BICARBONATE ions; POTASSIUM chloride; THERAPEUTIC use of vitamin D; DISEASES; THERAPEUTICS
- Publication
Indian Journal of Endocrinology & Metabolism, 2012, Vol 16, pS523
- ISSN
2230-8210
- Publication type
Article