title: A Rare Case of Type I RenalTubular Acidosis with Membranous Nephropathy Presenting as Hypokalemic Paralysis.
abstract: Type 1 renal tubular acidosis (RTA), or distal RTA (dRTA), is a disorder of renal tubular acidification, which is generally asymptomatic but may rarely present as hypokalemic paralysis. Here, we report the case of a young male who presented with sudden onset weakness of all 4 limbs and a 2-month history of swelling of the legs. An investigation revealed hypokalemia, metabolic acidosis, and nephrotic syndrome. Additional analyses revealed normal anion gap metabolic acidosis with a positive urine anion gap and dRTA. Renal biopsy showed evidence of membranous nephropathy (MN). The patient's weakness improved with potassium supplements. Normalization of the serum potassium level and disappearance of proteinuria were established with an ACE inhibitor and potassium supplementation. This case is an unusual combination of dRTA with MN coupled with the rare presenting symptoms of hypokalemic paralysis and medullary nephrocalcinosis.
authors.affiliation: Department of Nephrology, PGIMER, Dr. R.M.L. Hospital, New Delhi, India.
authors.forename: Sham
authors.initials: S
authors.lastname: Sunder
authors.forename: Satyanand
authors.initials: S
authors.lastname: Sathi
authors.forename: K
authors.initials: K
authors.lastname: Venkataramanan
authors.forename: Himanshu
authors.initials: H
authors.lastname: Verma
authors.forename: Minakshi
authors.initials: M
authors.lastname: Bhardwaj
authors.forename: J
authors.initials: J
authors.lastname: Rajesh
authors.forename: Himanshu
authors.initials: H
authors.lastname: Mahapatra
keywords: Distal renal tubular acidosis; Hypokalemic paralysis; Medullary nephrocalcinosis; Membranous nephropathy
references.citation: Am J Emerg Med. 2003 Oct;21(6):487-91
references.pmid: 14574658
references.citation: J Am Soc Nephrol. 2008 Feb;19(2):290-7
references.pmid: 18094368
references.citation: Ann Clin Biochem. 1999 Jul;36 ( Pt 4):408-22
references.pmid: 10456202
references.citation: Isr J Med Sci. 1993 May;29(5):300-3
references.pmid: 8314692
references.citation: J Am Soc Nephrol. 2002 Aug;13(8):2160-70
references.pmid: 12138150
references.citation: J Am Soc Nephrol. 2000 Jan;11(1):152-176
references.pmid: 10616852
references.citation: J Assoc Physicians India. 2011 Nov;59:735-7
references.pmid: 22616344
references.citation: Intern Med. 1992 May;31(5):662-5
references.pmid: 1504432
references.citation: N Engl J Med. 1982 Jul 22;307(4):217-21
references.pmid: 7088070
references.citation: Neth J Med. 2002 Mar;60(1):29-32
references.pmid: 12074041
references.citation: Semin Nephrol. 2006 Nov;26(6):471-8
references.pmid: 17275585