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Humayun Y, Sanchez P, Norris LT, et al. Kidney biopsy for renal tubular acidosis: when tissue diagnosis makes a difference. Clin Nephrol Case Stud. 2015;3:1-4doi: 10.5414/CNCS108412.
Humayun, Y., Sanchez, P., Norris, L. T., Monga, D., Lewin, J., & Fülöp, T. (2015). Kidney biopsy for renal tubular acidosis: when tissue diagnosis makes a difference. Clinical nephrology. Case studies, 31-4. https://doi.org/10.5414/CNCS108412
Humayun, Youshay, et al. "Kidney biopsy for renal tubular acidosis: when tissue diagnosis makes a difference." Clinical nephrology. Case studies vol. 3 (2015): 1-4. doi: https://doi.org/10.5414/CNCS108412
Humayun Y, Sanchez P, Norris LT, Monga D, Lewin J, Fülöp T. Kidney biopsy for renal tubular acidosis: when tissue diagnosis makes a difference. Clin Nephrol Case Stud. 2015 May 22;3:1-4. doi: 10.5414/CNCS108412. eCollection 2015. PMID: 29043125; PMCID: PMC5438002.
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Clin Nephrol Case Stud. 2015 May 22;3:1-4. doi: 10.5414/CNCS108412. eCollection 2015.

Kidney biopsy for renal tubular acidosis: when tissue diagnosis makes a difference.

Clinical nephrology. Case studies

Youshay Humayun, Patrick Sanchez, Lindsey T Norris, Divya Monga, Jack Lewin, Tibor Fülöp

Affiliations

  1. Department of Medicine and.
  2. Pathology, University of Mississippi Medical Center, Jackson, MS, USA.

PMID: 29043125 PMCID: PMC5438002 DOI: 10.5414/CNCS108412

Abstract

Renal tubular acidosis (RTA) is a disorder with variable presentations and oftentimes a nebulous underlying primary diagnosis. We describe a rare cause of RTA as an unusual complication of proton pump inhibitor (PPI) therapy. We report a case of a 33-year-old male with history of hypertension, acid reflux, allergic rhinitis, and low testosterone admitted with complaints of fatigue, weight loss, and unexplained acidosis for ~ 2 months. His medications prior to admission included losartan, omeprazole, potassium chloride, sildenafil, and testosterone propionate injections. His physical exam was unremarkable with a blood pressure of 120/80 mmHg. Initial lab work showed a nonanion gap metabolic acidosis with serum bicarbonate level of 16 mM/L and potassium 3 mM/L. Urine studies showed urine pH of 6.5 and a positive urine anion gap. The serum creatinine was within normal range(1.13 mg/dL). He required massive doses of bicarbonate and potassium supplementation with minimal improvement of serum chemistries achieved. The cause of apparent distal RTA remained elusive despite extensive blood, urine, and imaging testing. Ultimately a renal biopsy was obtained showing mild to moderate tubule-interstitial inflammation with 5% fibrosis. PPI therapy (omeprazole) was stopped, and he was started on prednisone 60 mg per day. Two weeks later, his RTA findings resolved, and he no longer required bicarbonate and potassium supplementation. Our case highlights the importance of recognizing a unique complication of RTA following PPI therapy. It also underscores the possible need for considering a kidney biopsy in the setting of nondiagnostic laboratory work up to uncover the underlying etiology of RTA and suspected allergic interstitial nephritis (AIN).

Keywords: allergic interstitial nephritis; distal renal tubular acidosis; hypokalemia; metabolic acidosis; omeprazole; proton-pump inhibitor

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