Proximal Renal Tubular Acidosis in Pregnancy

Abstract

Renal tubular acidosis is usually associated with chronic renal conditions and is rarely encountered in pregnancy. It may be inherited causing osteomalacia and rickets in children or acquired following autoimmune diseases or following exposure to nephrotoxic agents. It is known to worsen during pregnancy and if left untreated may cause maternal and foetal morbidity or death. We report a 28-year-old woman, gravida 3 para 2, who presented at 30 weeks gestation with lethargy, weakness and generalized myalgia. Investigation revealed severe hypokalaemia and a systemic metabolic acidosis due to proximal renal tubular acidosis. Her previous pregnancies were both complicated by foetal losses at term. Following prompt correction of her electrolyte disturbance and metabolic acidosis, she went on to deliver a healthy female infant at term. Regular evaluation up to 1 year post-partum revealed mild persistence of her hypokalaemia. At 1 year, the infant showed no signs of the disorder and is growing normally.

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

“…It is not clear why the clinical course seemed to worsen with each subsequent pregnancy in this patient. is has previously been reported in patients with CKD [18,24,25], suggesting further investigation into this phenomenon is required. However, it is important to acknowledge that in this group of patients, a previously uncomplicated pregnancy does not eliminate the risk of subsequent pregnancies developing complications.…”

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

“…The etiology of distal RTA in this case is not well understood. One report suggested that RTA could be transient in pregnant patients and that they recovered after delivery [ 6 ]. However, another report found that pregnancy could worsen RTA [ 3 ].…”

Hypokalemic Paraplegia in Pregnancy

“…The rennin-angiotensinaldosterone axis was normal, so also the urinary calcium levels, hence Bartter's syndrome [4], Gittleman syndrome [5] and Bartter like conditions were ruled out. There was no metabolic acidosis and renal function tests were normal, not suggestive of distal or proximal renal tubular acidosis [6][7][8][9][10]. There was no history of pica in this lady to suggest ingestion of any unusual substance [11].…”