Secondary distal renal tubular acidosis and sclerotic metabolic bone disease in seronegative spondyloarthropathy

Abstract

Adults with distal renal tubular acidosis (dRTA) commonly present with hypokalaemia (with/without paralysis), nephrolithiasis/nephrocalcinosis and vague musculoskeletal symptoms. All adults with dRTA should be thoroughly evaluated for systemic diseases, certain medications and toxins. The leading cause of acquired or secondary dRTA in adults is primary Sjögren syndrome (SS); however, other collagen vascular diseases (CVDs) including seronegative spondyloarthropathy (SSpA) may at times give rise to secondary dRTA. Metabolic bone disease is often encountered in adults with dRTA, and the list includes osteomalacia and secondary osteoporosis; sclerotic metabolic bone disease is an extremely rare manifestation of dRTA. Coexistence of dRTA and sclerotic bone disease is seen in primary dRTA due to mutation in CA2 gene and acquired dRTA secondary to systemic fluorosis. Primary SS and SSpA, rarely if ever, may also lead to both secondary dRTA and osteosclerosis. Circulating autoantibodies against carbonic anhydrase II and possibly calcium sensing receptor may explain both these features in patients with CVD.

Renal tubular acidosis as one of the causes of urolithiasis.

“…Сообщается, что помимо синдрома Шегрена к вторичному ПКА дистального типа могут приводить и другие аутоиммунные заболевания, такие как серонегативная спондилоартропатия, системная красная волчанка, ревматоидный артрит, тиреоидит Хашимото [56][57][58].…”

Urolithiasis and renal tubular acidosis.

“…Тем не менее, заболевание может манифестировать и во взрослом возрасте. Данный тип тубулопатии может носить и приобретенный характер [7][8][9][10][11][12].…”