A rare case report on primary sjogren’s syndrome complicating as osteomalacia with renal tubular acidosis in a tertiary care teaching hospital tirupathi

Abstract

Renal involvement in Sjogren’s syndrome (SS) is not uncommon and may precede other complaints. Tubulointerstitial nephritis is the most common renal disease in SS and may lead to, renal tubular acidosis (RTA), which in turn may cause osteomalacia. Nevertheless, osteomalacia rarely occurs as the first manifestation of a renal tubule connective tissue disorder due to SS. Here we are presenting a female patient of age 41 yrs was admitted in our hospital with chief complaints of bilateral thigh pain which restrict her walking with weakness. x-ray of long bone shows that extensive demineralization of the bone. Laboratory investigations revealed hypokalemia (3.2 mmol/L), hypophosphatemia (0.4 mmol/L), hypocalcemia (2.14 mmol/L) and hyperchloremic metabolic acidosis (chlorine: 214 mmol/L; alkaline reserve: 14 mmol/L). The serum alkaline phosphatase levels were elevated. The serum levels of 25-hydroxyvitamin D and 1,25-dihydroxy vitamin D were low and borderline low, respectively, and the parathyroid hormone level was 90 pg/L. Urinalysis showed inappropriate alkaline urine (urinary PH: 7), glycosuria. These values indicated the presence of both distal and proximal RTA. Our patient reported dryness of the mouth and eyes and Schirmer’s test showed xerophthalmia.