A Case of Mixed Type Renal Tubular Acidosis with Primary Sjogren`s Syndrome / 대한신장학회지

ABSTRACT

56-year old woman was hospitalized for severe weakness and generalized bone pain, so she was immediately evaluated for the multiple bone lesions under the impression of malignancy with bone metastasis at the department of oncology. No underlying malignancy was found and the patient was referred to the division of nephrology, where patient was diagnosed as mixed type renal tubular acidosis (RTA) with clinical features of both type 1 and type 2 RTA. Type 2 RTA was diagnosed by high fractional excretion of bicarbonate over 15% and multiple bone lesions, and type 1 RTA was diagnosed by the presence of nephrocalcinosis and sustained high urine pH over 7.0 in spite of severe metabolic acidosis (pH <7.2) with low serum bicarbonate level. She also had findings characteristic of primary Sjogrens syndrome. The treatment started with sodium bicarbonate, vitamin D, calcium and analgesics. In the following seven months, acidosis and symptoms such as bone pain were improved gradually.