Case report: disease mechanisms and medical management of calcium nephrolithiasis in rheumatologic diseases
Abstract Background Nephrolithiasis as a feature of rheumatologic diseases is under recognized. Understanding presenting features, diagnostic testing is crucial to proper management. Case presentation A 32 year old woman with a history of recurrent complicated nephrolithiasis presented to a rheumato...
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| Format: | Article |
| Language: | English |
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BMC
2023-03-01
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| Series: | BMC Urology |
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| Online Access: | https://doi.org/10.1186/s12894-023-01203-y |
| _version_ | 1797859845376835584 |
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| author | Omar Osman Susan Manzi Mary Chester Wasko Barbara A. Clark |
| author_facet | Omar Osman Susan Manzi Mary Chester Wasko Barbara A. Clark |
| author_sort | Omar Osman |
| collection | DOAJ |
| description | Abstract Background Nephrolithiasis as a feature of rheumatologic diseases is under recognized. Understanding presenting features, diagnostic testing is crucial to proper management. Case presentation A 32 year old woman with a history of recurrent complicated nephrolithiasis presented to a rheumatologist for a several month history of fatigue, dry eyes, dry mouth, arthralgias. She had a positive double-stranded DNA, positive SSA and SSB antibodies. She was diagnosed with Systemic Lupus erythematosus (SLE) and Sjogren's syndrome and was started on mycophenalate mofetil. Of relevance was a visit to her local emergency room 4 years earlier with profound weakness with unexplained marked hypokalemia and a non-anion gap metabolic acidosis. Approximately one year after that episode she developed flank pain and nephrocalcinosis. She had multiple issues over the ensuing years with stones and infections on both sides. Interventions included extracorporeal shockwave lithotripsy as well as open lithotomy and eventual auto-transplantation of left kidney for recurrent ureteric stenosis. 24 h stone profile revealed marked hypocitraturia, normal urine calcium, normal urine oxalate and uric acid. She was treated with potassium citrate. Mycophenolate was eventually stopped due to recurrent urinary tract infections and she was started on Belimumab. Because of recurrent SLE flares, treatment was changed to Rituximab (every 6 months) with clinical and serologic improvement. Her kidney stone frequency gradually improved and no further interventions needed although she continued to require citrate repletion for hypocitraturia. Conclusions Nephrolithiasis can be a prominent and even presenting feature in Sjogrens syndrome as well as other rheumatologic diseases. Prompt recognition and understanding disease mechanisms is important for best therapeutic interventions for kidney stone prevention as well as treatment of underlying bone mineral disease. |
| first_indexed | 2024-04-09T21:36:12Z |
| format | Article |
| id | doaj.art-caf8be6131424cf3a270e2e4717d8d13 |
| institution | Directory Open Access Journal |
| issn | 1471-2490 |
| language | English |
| last_indexed | 2024-04-09T21:36:12Z |
| publishDate | 2023-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Urology |
| spelling | doaj.art-caf8be6131424cf3a270e2e4717d8d132023-03-26T11:18:30ZengBMCBMC Urology1471-24902023-03-0123111010.1186/s12894-023-01203-yCase report: disease mechanisms and medical management of calcium nephrolithiasis in rheumatologic diseasesOmar Osman0Susan Manzi1Mary Chester Wasko2Barbara A. Clark3Department of Medicine, Allegheny Health NetworkDepartment of Medicine, Allegheny Health NetworkDepartment of Medicine, Allegheny Health NetworkDepartment of Medicine, Allegheny Health NetworkAbstract Background Nephrolithiasis as a feature of rheumatologic diseases is under recognized. Understanding presenting features, diagnostic testing is crucial to proper management. Case presentation A 32 year old woman with a history of recurrent complicated nephrolithiasis presented to a rheumatologist for a several month history of fatigue, dry eyes, dry mouth, arthralgias. She had a positive double-stranded DNA, positive SSA and SSB antibodies. She was diagnosed with Systemic Lupus erythematosus (SLE) and Sjogren's syndrome and was started on mycophenalate mofetil. Of relevance was a visit to her local emergency room 4 years earlier with profound weakness with unexplained marked hypokalemia and a non-anion gap metabolic acidosis. Approximately one year after that episode she developed flank pain and nephrocalcinosis. She had multiple issues over the ensuing years with stones and infections on both sides. Interventions included extracorporeal shockwave lithotripsy as well as open lithotomy and eventual auto-transplantation of left kidney for recurrent ureteric stenosis. 24 h stone profile revealed marked hypocitraturia, normal urine calcium, normal urine oxalate and uric acid. She was treated with potassium citrate. Mycophenolate was eventually stopped due to recurrent urinary tract infections and she was started on Belimumab. Because of recurrent SLE flares, treatment was changed to Rituximab (every 6 months) with clinical and serologic improvement. Her kidney stone frequency gradually improved and no further interventions needed although she continued to require citrate repletion for hypocitraturia. Conclusions Nephrolithiasis can be a prominent and even presenting feature in Sjogrens syndrome as well as other rheumatologic diseases. Prompt recognition and understanding disease mechanisms is important for best therapeutic interventions for kidney stone prevention as well as treatment of underlying bone mineral disease.https://doi.org/10.1186/s12894-023-01203-yCase reportNephrolithiasisRenal tubular acidosisSjogrens syndromeSarcoidosisCrohn’s disease |
| spellingShingle | Omar Osman Susan Manzi Mary Chester Wasko Barbara A. Clark Case report: disease mechanisms and medical management of calcium nephrolithiasis in rheumatologic diseases BMC Urology Case report Nephrolithiasis Renal tubular acidosis Sjogrens syndrome Sarcoidosis Crohn’s disease |
| title | Case report: disease mechanisms and medical management of calcium nephrolithiasis in rheumatologic diseases |
| title_full | Case report: disease mechanisms and medical management of calcium nephrolithiasis in rheumatologic diseases |
| title_fullStr | Case report: disease mechanisms and medical management of calcium nephrolithiasis in rheumatologic diseases |
| title_full_unstemmed | Case report: disease mechanisms and medical management of calcium nephrolithiasis in rheumatologic diseases |
| title_short | Case report: disease mechanisms and medical management of calcium nephrolithiasis in rheumatologic diseases |
| title_sort | case report disease mechanisms and medical management of calcium nephrolithiasis in rheumatologic diseases |
| topic | Case report Nephrolithiasis Renal tubular acidosis Sjogrens syndrome Sarcoidosis Crohn’s disease |
| url | https://doi.org/10.1186/s12894-023-01203-y |
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