Renal Tubular Acidosis (RTA) refers to a condition where the kidneys do not appropriately eliminate acids from the blood into the urine resulting in acid remnants in the blood. It could be caused either by dysfunction of distal renal tubules or proximal renal tubules. Homeostasis of the cells, cochlear fluids and generation of endocochlear potential are important factors which enable normal cochlear function. Hearing loss can be caused by disturbances in cochlear homeostasis due to certain gene mutations. In this report, a child with proximal Renal Tubular Acidosis who was evaluated and diagnosed as having bilateral sensorineural hearing loss is documented. This report aims to highlight the importance of early diagnosis of hearing loss and provide appropriate intervention to reduce the impact of hearing loss on the child's language, speech, education and social life.

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BACKGROUND Chikungunya Fever, though known to be a self-limiting disease, causes severe disabling joint involvement, which in turn lays a significant burden on the health care system. Although mortality related to this illness is low, there is significant interference with the ability of a patient to perform routine daily activities due to polyarthritis. The objective of our study is thus to analyse the clinical profile of patients with Chikungunya fever. METHODS OPD and IPD patients with symptoms of fever and joint pains who presented to a tertiary care center in Ludhiana, Punjab were included in the study. They were tested for Chikungunya (CHIKV IgM antibody) and those who were positive (confirmed cases) were in turn recruited to the study. Their clinical profiles, laboratory features, complications and outcomes were studied. RESULTS A total of 88 patients formed our study group, all of whom tested positive for CHIKV IgM antibody. Male:Female ratio was 1:1.3, with the mean age of patients enrolled being 43±18.4 years. A majority, 18 (20.5%) of them were in the 31-40-year age group. Most of the patients i.e. 72 (81.8%) presented within the first 7 days of illness. The main symptom was fever, seen in 67 (76.3%) patients. The knee joint was seen to be involved in a majority of patients 60(68.2%), followed by the elbow joint in 40 (45.5%) of them. Diabetes mellitus was the most commonly observed co-morbidity, seen in 15 (17%) patients. Co-infection with Dengue was seen in 8 (9.1%) patients, 1 of whom died. 8 (9.1%) patients demonstrated leucopenia, while 52 (59.1%) had transaminitis. While 67 (76%) patients required treatment on IPD basis. The mean duration of hospital stay was 4 ± 3.96 days. 29 (33%) patients required the administration of steroids in addition in NSAIDs. Also, 37 (42%) had arthritis on follow up. Overall, 86 (97.7 %) patients were discharged while 2 (2.3%) expired. Both of these patients had documented multisystemic involvement. CONCLUSIONS Chikungunya fever, though a self-limiting disease can be very debilitating, and in its severe form, can cause multiorgan involvement and mortality.