title: Proximal renal tubular acidosis associated with osteomalacia.
abstract: Vitamin D deficiency is relatively common among older persons and those with spinal cord injuries. We report a case of proximal renal tubular acidosis in a 44-year-old quadriplegic nursing home resident who had limited sunlight exposure. Laboratory studies showed a low level of serum bicarbonate, a normal serum anion gap, and a positive urine anion gap. There was no history of diarrhea. Serum calcium and phosphorus levels were 6.9 mg/dL and 3.7 mg/dL, respectively. Proximal renal tubular acidosis due to osteomalacia was suspected, which was confirmed by a low serum 25-hydroxycholecalciferol level (< 5 ng/mL) with an elevated serum parathyroid hormone level. Treatment with vitamin D and a calcium supplement led to normalization of laboratory values.
authors.affiliation: Department of Medicine, University of Alabama at Birmingham School of Medicine, Veterans Affairs Medical Center, 35294-2041, USA.
authors.forename: A
authors.initials: A
authors.lastname: Ahmed
authors.forename: R V
authors.initials: RV
authors.lastname: Sims
mesh_terms: D000141:Acidosis, Renal Tubular / Q000175:diagnosis / Q000209:etiology*; D000328:Adult; D015415:Biomarkers; D002112:Calcifediol / Q000097:blood; D002118:Calcium / Q000627:therapeutic use; D006801:Humans; D008297:Male; D010018:Osteomalacia / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control; D011782:Quadriplegia / Q000150:complications*; D012307:Risk Factors; D014807:Vitamin D / Q000627:therapeutic use
chemical_list: D015415:Biomarkers; D014807:Vitamin D; D002112:Calcifediol; D002118:Calcium