Abstract: PUB242
Hypokalemic Distal Renal Tubular Acidosis (HdRTA) During Pregnancy Is Associated with Tubulointerstitial Nephritis (TIN) Due to Sjögren Disease (SjD)
Session Information
Category: Women's Health and Kidney Diseases
- 2100 Women's Health and Kidney Diseases
Authors
- Hogan-Moulton, Amy E., Sratoga, Glens Falls Hospital ( Albany Medical Health System), Saratoga Springs, New York, United States
- Mihindu, Joseph C., Sratoga, Glens Falls Hospital ( Albany Medical Health System), Saratoga Springs, New York, United States
Group or Team Name
- Saratoga and Glens Falls Hospitals (Albany Medical Health System)
Introduction
Pregnancy associated HdRTA due to TIN in SjD is a rare condition. It presents unique clinical challenges with possible maternal and fetal complications including Acute Kidney injury(AKI), Hypertension, Fetal congenital heart block(CHB), intrauterine growth retardation(IUGR) and neonatal autoimmune disease due to placental antibody transfer. Prompt diagnosis and Multidisciplinary management is required.
Case Description
A 32 yr old Caucasian female in 35 wk of G3P2 was evaluated for HdRTA. Clinical history included dry eyes, dry mouth, muscle cramps, negative for arthritis, diarrhea, Laxative use, GI disease, Nephrotoxics, NSAIDs nor familial renal electrolyte disease. Physical exam showed normal BP, uterine enlargement; otherwise normal. Laboratory data showed WBC 3.4,HB 13.7, Platelets 144, normal BUN, Creatinine 1.22mg/dl, Urinalysis: trace blood and leukocytes, no protein, pH 7, normal sediment, Serum electrolytes Eq/L: Na 142 K 3.3, Cl 110, CO2 19, Serologies: ANA 1:1280(speckled pattern), positive SSa(Ro) >8(N:<0.9), SSB (La)6.4(N:0,<.9), negative anti DS DNA, RNP, normal complement, ß2 glycoprotein and negative Genetic Panel.
She received Hydroxychloquin, HdRTA correction and Multidisciplinary intervention, She had normal BP, stable renal function and electrolytes; normal delivery of healthy baby. Three months postpartum early renal function decline was noted. Renal Biopsy showed: Acute on Chronic TIN with predominant Lymphocytic infiltrate with few Plasmacell and eosinophils, IM showed no Immunoglobulin or complement deposits; negative for lupus. Azathioprine was added with improvement of renal function.
Discussion
Patient had stable renal function and no maternal fetal complications during pregnancy, however, had postpartum renal decline; well described in literature. There is paucity of data on management and controversy on clinical outcome in literature. Patients developing AKI during pregnancy have required Renal biopsy, immunosuppression with Steroids and Azathioprine. Prolonged high dose steroids may risk fetal adverse effects including IUGR. Hydroxychloquin is recommended to reduce Fetal complications. Recommendation made for fetal growth and CHB monitoring including fetal ECHO cardiography. Renal complications of SjD during pregnancy, although rare, present complex clinical challenges requiring multidisciplinary management.