Renal tubular acidosis as the initial presentation of Sjögre
Sjögren’s syndrome is a rare autoimmune condition typically involving chronic inflammation of exocrine organs such as lacrimal and salivary glands, typically manifesting as dry eyes and mouth.

A 44-year-old female was initially seen in the nephrology outpatient clinic for evaluation of hypokalaemia. She reported feeling tired and listless for 4 months prior to her review. There was no history of diabetes mellitus, hypertension or rheumatological illnesses, and in particular, she denied a history of dry eyes and mouth. She had no history of nephrolithiasis or pre-existing renal disease. Systems review did not reveal abdominal pain, emesis, diarrhoea, painful swollen stiff joints or the use of non-steroidal anti-inflammatories (NSAIDs).

Without a history of gastrointestinal losses or administration of intravenous fluids, a diagnosis of renal tubular acidosis (RTA) was contemplated. The presence of metabolic acidosis and a urine pH of 6.5 support a diagnosis of distal (type I) RTA. As myeloma is associated with renal tubular anomalies including RTA, she was investigated further with serum protein electrophoresis, which revealed polyclonal elevation of IgG. There was no monoclonal band identified on serum immunofixation. Urine for immunofixation did not reveal any Bence Jones protein.

Source: BMJ case reports

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