A case of distal renal tubular acidosis associated with Sjoegren's syndorome, Hashimoto's thyroiditis and chronic hepatitis.

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The present paper reports a case with distal renal tubular acidosis associated with Sjogren's syndrome, Hashimoto's thyroiditis and chronic hepatitis. A 44-year-old woman was admitted because of muscular weakness and pain of the leg for several weeks. The laboratory findings revealed remakable hypokalemia of 1.3 mEq, /1 and metabolic acidosis of pH 7.369, Pco<SUB>2</SUB> 36.9 mmHg, HCO<SUB>3</SUB> 15.2 mEq/l and BE -8.7 mEq/1. Urinary acidification was studied before and during the oral ammonium chloride, and urinary pH did not fall below 5.5. The urinary fractional excretion of bicarbonate was 3% in the oral administration of 6g of sodium bicarbonate per day. From the laboratory findings and the clinical signs, the present case was diagnosed as a distal renal tubular acidosis. Other clinical date including biopsy examination showed that the patient was also suffering from Sjogren's syndrome, Hashimoto's thyroiditis and chronic inactive hepatitis. Marked lymphatic infiltration was noted in the biopsy specimens of the kidney, salivary gland, thyroid gland and liver. It has been suggested that all these lesions were caused by the common autoimmune mechanism, and antibodies against the epithelium of renal tubules, salivary glands, thyroid follicles and bile ducts were also commons.
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