Hypokalemia-Induced Rhabdomyolysis as a result of Distal Renal Tubular Acidosis in a Pregnant Woman: A Case Report and Literature Review

Srisuttayasathien, Manasawee

doi:10.1155/2015/947617

Cited by 11 publications

(12 citation statements)

References 6 publications

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“…Additionally, severe hypokalemia may result in paralysis and eventually rhabdomyolysis as reported in several case reports of pregnant women with RTA. This was not observed in our patients potentially due to close monitoring and timely treatment 7,9 . One of our patients was additionally suffering from recurrent UTI and obstruction requiring long-term antibiotic treatment and ureteric stenting.…”

Section: Discussionmentioning

confidence: 61%

“…In contrast to Rowe et al none of our patients developed hypertension during pregnancy and kidney function remained stable postpartum 10 . Fortunately, all deliveries were uneventful with healthy term neonates as reported in the literature [7][8][9][10] suggesting no adverse impact on child outcome in RTA patients.…”

Section: Discussionmentioning

confidence: 83%

“…Single case reports have reported pregnancy in several types of RTA (proximal, distal, inherited, secondary) to be predominantly complicated by hypokalemia [7][8][9] or hypertension 10 . Here, we report a series of three women with inherited dRTA developing several complications during pregnancy.…”

Section: Introductionmentioning

confidence: 99%

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Complicated pregnancies in inherited distal renal tubular acidosis: importance of acid-base balance

et al. 2016

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Inherited distal renal tubular acidosis (dRTA) is caused by impaired urinary acid excretion resulting in hyperchloremic metabolic acidosis. Although the glomerular filtration rate (GFR) is usually preserved, and hypertension and overt proteinuria are absent, it has to be considered that patients with dRTA also suffer from chronic kidney disease (CKD) with an increased risk for adverse pregnancy-related outcomes. Typical complications of dRTA include severe hypokalemia leading to cardiac arrhythmias and paralysis, nephrolithiasis and nephrocalcinosis. Several physiologic changes occur in normal pregnancy including alterations in acid-base and electrolyte homeostasis as well as in GFR. However, data on pregnancy in women with inherited dRTA are scarce. We report the course of pregnancy in three women with hereditary dRTA. Complications observed were severe metabolic acidosis, profound hypokalemia aggravated by hyperemesis gravidarum, recurrent urinary tract infection (UTI) and ureteric obstruction leading to renal failure. However, the outcome of all five pregnancies (1 pregnancy each for mothers n. 1 and 2; 3 pregnancies for mother n. 3) was excellent due to timely interventions. Our findings highlight the importance of close nephrologic monitoring of women with inherited dRTA during pregnancy. In addition to routine assessment of creatinine and proteinuria, caregivers should especially focus on acid-base status, plasma potassium and urinary tract infections. Patients should be screened for renal obstruction in the case of typical symptoms, UTI or renal failure. Furthermore, genetic identification of the underlying mutation may (a) support early nephrologic referral during pregnancy and a better management of the affected woman, and (b) help to avoid delayed diagnosis and reduce complications in affected newborns.

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Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 83%

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Complicated pregnancies in inherited distal renal tubular acidosis: importance of acid-base balance

et al. 2016

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“…Her history and the complications of her previous pregnancies made her case particularly challenging. Firstly, maintenance of stable plasma levels of solutes and normal serum pH was essential as severe prolonged metabolic acidosis in pregnancy is known to impair fetal circulation and cause fetal distress [16]. Early in gestation, outpatient intravenous bicarbonate infusions were commenced, in addition to oral supplementation, to achieve this.…”

Section: Discussionmentioning

confidence: 99%

A Complicated Pregnancy in an Adult with HNF4A p.R63W-Associated Fanconi Syndrome

Anyiam

Wallin

Kaplan

et al. 2019

Case Reports in Medicine

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Renal Fanconi syndrome (RFS) is characterised by generalised dysfunction of the proximal renal tubules, resulting in excessive urinary loss of solutes, most notably bicarbonate, and type II (proximal) renal tubular acidosis. It is a rare condition, and literature around its management through pregnancy is limited. We present the management of a 37-year-old woman with RFS secondary to the HNF4A p.R63W mutation, through her third pregnancy. She presented at 28 + 5 weeks with dehydration, low serum bicarbonate, and profound metabolic acidosis. Daily infusions of sodium bicarbonate were necessary, and the requirements increased throughout the pregnancy. She also demonstrated both fasting hypoglycaemia and episodes of postprandial hyperglycaemia which required complex management. Due to concerns around fetal health, an elective caesarean section was performed at 34 weeks, delivering a healthy baby girl. This case highlights the potential complexity of pregnancy in patients with RFS and the need for a multidisciplinary approach to its management.

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“…However, patients with inherited dRTA usually have a normal kidney function with preserved estimated GFR (eGFR) and therefore are often not perceived as CKD patients. Nevertheless, several case reports have described severe complications during pregnancy in female patients with different types of RTA[72][73][74][75]. We have recently reported a series of three pregnant women with inherited dRTA with exacerbated acid-base disturbances during pregnancy[76].All three patients presented with profound hypokalemia and worsening of metabolic acidosis during pregnancy.…”

mentioning

confidence: 95%

Pathophysiology, diagnosis and treatment of inherited distal renal tubular acidosis

Mohebbi

Wagner

2017

J Nephrol

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Distal renal tubular acidosis (dRTA) is a tubular disorder with a primary defect of urinary acidification and acid excretion in the collecting duct system. Consequently, patients develop hyperchloremic metabolic acidosis with an inappropriately alkaline urine. Inherited forms of dRTA are due to mutations in at least three distinct genes: SLC4A1, ATP6V1B1, ATP6V0A4. Mutations in SLC4A1-(AE1) are inherited either in an autosomal dominant manner or in a recessive one. ATP6V1B and ATP6V0A4 mutations affect two different subunits of the vacuolar H-ATPase proton-pump, the B1 and a4 subunits, and are inherited in an autosomal recessive manner. Clinical manifestations of inherited forms of dRTA usually occur during infancy or childhood. However, heterozygous carriers of ATP6V1B1 and ATP6V0A4 mutations may have a higher risk of developing nephrolithiasis and nephrocalcinosis in adulthood, respectively. In full forms of dRTA, patients may present with mild clinical symptoms, such as mild metabolic acidosis and incidental detection of kidney stones, as well as with more severe manifestations such as failure to thrive, severe metabolic acidosis, and nephrocalcinosis. Progressive sensorineural hearing loss develops in the majority of patients with recessive dRTA (ATP6V1B1 and ATP6V0A4 mutations). Some patients with recessive dRTA may also develop abnormal widening of the vestibular aqueduct. This review will discuss our current understanding of the pathophysiology of inherited forms of dRTA, diagnosis and prognosis of patients, and therapy.

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Hypokalemia-Induced Rhabdomyolysis as a result of Distal Renal Tubular Acidosis in a Pregnant Woman: A Case Report and Literature Review

Cited by 11 publications

References 6 publications

Complicated pregnancies in inherited distal renal tubular acidosis: importance of acid-base balance

Complicated pregnancies in inherited distal renal tubular acidosis: importance of acid-base balance

A Complicated Pregnancy in an Adult with HNF4A p.R63W-Associated Fanconi Syndrome

Pathophysiology, diagnosis and treatment of inherited distal renal tubular acidosis

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