md-medicaldata


Go to content

HIPOKALIJEMIJSKA PARALIZA U SJÖGRENOVOM SINDROMU KAO POSLEDICA TUBULOINTERSTICIJSKOG NEFRITISA /
HYPOKALEMIC PARALYSIS IN SJÖGREN’S SYNDROME SECONDARY TO TUBULOINTERSTITIAL NEPHRITIS

Authors

 

Sonja Golubović1, Tatjana Ilić1,2, Biljana Milić1,2, Dejan Ćelić1,2, Igor Mitić1,2

1Klinički centar Vojvodine, Klinika za nefrologiju i kliničku imunologiju, Hajduk Veljkova 1 21000 Novi Sad, Srbija
2Univerzitet u Novom Sadu, Medicinski fakultet, Hajduk Veljkova 1, 21000 Novi Sad, Srbija

 

UDK: 616.316
616.61-002


The paper was received / Rad primljen: 09.10.2018.

Accepted / Rad prihvaćen: 12.10.2018

 


Correspondence to:


Dr Sonja Golubović
Klinički centar Vojvodine, Klinika za nefrologiju i kliničku imunologiju,
Hajduk Veljkova 1 21000 Novi Sad, Srbija,
21204 Sremska Kamenica, Serbia
Tel: +381644090506
e-mail: sonjagolubovic@gmail.com

 

 

Sažetak

 

Uvod: Sjögrenov sindrom je hronična sistemska bolest vezivnog tkiva koja zahvata razne organe, a primarno egzokrine žlezde. Predstavićemo slučaj bolesnice sa hipo­kalemijskom kvadriparezom nastalom kao posledica tubulointersticijskog nefritisa i renalne tubularne acidoze a kao jedna od manifestacija Sjögrenovog sindroma. Prikaz slučaja: Žena starosti 41 godinu primljena u Urgentni centar zbog prisustva tegoba u vidu slabosti, bolova u mišićima i otežanom pokretljivošću sva četiri ekstremiteta. Dijagnoza primarnog Sjögrenovog sindroma je postavljena 11 godna ranije. Inicijalne laboratorijske analize pokazale su izraženu hipokalijemiju sa metaboličkom acidozom, ubrzanu sedimentaciju, hiperhloremiju i hipernatrijemiju. Imunoserološki testovi su potvrdili prisu­stvo tačkastih antinuklearnih antitela uz prisustvo anti-SSA i anti-SSB antitela. Nalaz imunofluorescentne mikroskopije bioptata bubrega ukazala je na gusto infiltrisan hipe­rcelularni intersticijumski segment bez prisustva imunofluorescentnih depozita unutar glomerula. Analiza svetlosne mikroskopije se uklapala u kliničku sliku tubulo­inter­sticijskog nefritisa. Zaključak: Jedan od prezentujućih znakova autoimunog obo­ljenja može biti nespecifičan što je prikazano u ovom slučaju gde hipokalijemijska paraliza i renalni kalkulusi mogu biti pokazatelji prisustva distalne renalne tubularne acidoze.

 

 

Ključne reči:

hipokalijemijska paraliza, intersticijumski nefritis, renalna tubularna acidoza, Sjögrenov sindrom

 

 

Abstract

 

Introduction: Sjögren’s syndrome  is a chronic systemic connective tissue disease which can affect multiple visceral organs, primarily affecting exocrine glands. We present a case of a patient with hypokalemic quadriparesis due to tubulointerstital nephritis and renal tubular acidosis, as a manifestation of Sjögren’s syndrome. Case Outline: A 41-year-old woman was admitted to the emergency room due to weakness, muscle pain, difficulties walking and moving all four limbs. She was diagnosed with primary Sjögren’s syndrome 11 years earlier. Laboratory results showed extreme hypokalemia with metabolic acidosis, increased erythrocyte sedimentation rate, hyperchloremia and hypernatremia. Imunoserologic tests confirmed the presence of speckled ANA with the presence of anti SSA and anti SSB antibodies. Imunofluorescent microscopy of the renal biopsy sample revealed a densely infiltrated hypercellular interstitial segment without presence of imunofluorescent deposits within the glomerulus. Тhe finding of light microscopic analysis fits into the clinical picture of tubulointerstitial nephritis. Conclusion: One of presenting signs of an autoimmune disease can be unspecific, such as hypokalemic paralysis and renal calculi which could further indicate the presence of distal renal tubular acidosis.

 

 

Key words:

Hypokalemic paralysis, interstitial nephritis, renal tubular acidosis, Sjögren’s syndrome

 

 

References:

 

  1. Fox RI. Sjögren’s syndrome. A detailed review. Lancet 2005;366:321-31. doi:10.1016/S0140-673666990-5
  2. Mugundhan K, Mayan Vasif MC, Nidhin PD, Prakash G, Balamurugan N, Sivakumar KG, et al. Hypokalemic paralysis in Sjogren’s syndrome secondary to renal tubular acidosis. J Assoc Phys India 2016;64:72. PMID: 27731561
  3. Evans R, Zdebik A, Ciurtin C, Walsh SB. Renal involvement in primary Sjögren’s syndrome. Rheumatology . 2015;54:1541-8. doi: 10.1093/rheumatology/kev223. 
  4. Ramos-Casals M, Brito-Zeròn P, Seror R, Bootsma H, Bowman SJ, Dörner T, et al. Corrigendum: Characterization of systemic disease in primary Sjögren’s syndrome: EULAR-SS Task Force recommendations for articular, cutaneous, pulmonary and renal involvements. Rheumatology . 2017;56:1245. doi: 10.1093/rheumatology/kex157. .
  5. Asplin JR, Coe FL. Tubular disorders. In: Kasper DL, Braunwald E, Fauci AS, eds. Harrison’s Principle of Internal Medicine. 16th ed. U.S.A. The McGraw-Hill Companies, Inc; 2005;1698–9.
  6. Shiboski CH, Shiboski SC, Seror R, Criswell LA, Labetoulle M, Lietman TM, et al. 2016 American College of Rheumatology/European League Against Rheumatism Classification Criteria for Primary Sjögren’s Syndrome: A Consensus and Data-Driven Methodology Involving Three International Patient Cohorts. Arthritis Rheum 2017;69:35-45.
  7. Bossini N, Savoldi S, Franceschini F, Mombelloni S, Baronio M, Cavazzana I, et al. Clinical and morphological features of kidney involvement in primary Sjögren’s syndrome. Nephrol Dial Transplant 2001;16:2328-36. PMID:11733624
  8. Pertovaara M, Korpela M, Kouri T, Pasternack A. The occurrence of renal involvement in primary Sjogren’s syndrome: A study of 78 patients. Rheumatol 1999;38:1113-20. PMID:10556265
  9. Hassen BG, Salah S, Imen BC, Jhen O. Sjögren’s syndrome presenting with hypokalemic paralysis. Case Rep Int 2015;4:26–29. doi:10.5348/crint
  10. Goroshi M, Khare S, Jamale T, Shah NS. Primary Sjögren’s syndrome presenting as hypocalcemic paralyisis: A case series. J Postgrad Med 2017,63:128-31. doi: 10.4103/0022-3859.194224
  11. Soy M, Pamuk ÖN, Gerenli M, Çelik Y. A primary Sjögren’s syndrome patient with distal renal tubular acidosis, who presented with symptoms of hypokalemic periodic paralysis : Report of a case study and review of the literature. Rheumatol Int 2005;26:86-9. PMID:15690142
  12. Garza-Alpirez A, Arana-Guajardo AC, Esquivel-Valerio JA, Villarreal-Alarcón MA, Galarza-Delgado DA: Hypokalemic Paralysis due to Primary Sjögren Syndrome: Case Report and Review of the Literature. Case Rep Rheumatol. 2017:7509238. doi: 10.1155/2017/7509238. 
  13. Vitali C, Palombi G, Cataleta P. Treating Sjögren’s syndrome: Insights for the clinician. Ther Adv Musculoskelet Dis 2010;2:155-66. doi: 10.1177/1759720X10363246.

PDF Golubović S. et al. • MD-Medical Data 2018;10(4): 197-200

 

 

 

Naslovna | Revija | Galerija | Dešavanja | Instrukcije | Redakcija | Izdavač | Prijatelji sajta | Saradnja | Kontakt | Site Map


Back to content | Back to main menu