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Reminder of important clinical lesson
CASE REPORT
Glucosuria without diabetes: key to the diagnosis of fragility fractures due to Fanconi syndrome
  1. Lilluck F Alacapa1,
  2. Mark Anthony Santiago Sandoval1,2,
  3. Coralie Therese D Dimacali3,
  4. Nathaniel Jr S Orillaza4
  1. 1Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
  2. 2Department of Physiology, College of Medicine, University of the Philippines Manila, Manila, Philippines
  3. 3Section of Nephrology, Department of Medicine, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
  4. 4Department of Orthopedics, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
  1. Correspondence to Dr Mark Anthony Santiago Sandoval, markanthony_sandoval{at}yahoo.com

Summary

A 64-year-old woman had fragility fractures which caused her to have gross deformities and confined her to bed. These were initially ascribed to vitamin D deficiency. However, despite correction of the deficiency, she did not improve. A review of previous records already showed glucosuria in the absence of diabetes, but this finding was overlooked. Eight years into the disease, it was realised that the glucosuria despite normal blood sugar could also mean that the patient was losing other substances needed for proper bone formation. Further investigations showed hypophosphataemia, renal phosphate wasting, hypokalaemia, mild metabolic acidosis, alkaline urine pH, hypouricaemia and aminoaciduria, all compatible with a proximal renal tubular defect (Fanconi syndrome). The fragility fractures were due to poor bone mineralisation because of hypophosphataemia induced by the inability of the kidneys to conserve phosphorus.

  • calcium and bone
  • renal medicine
  • fluid electrolyte and acid-base disturbances
  • orthopaedics

https://doi.org/10.1136/bcr-2017-223350

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    Footnotes

    • Contributors LFA wrote the first draft of the manuscript. MASS provided significant revisions and contributions to the manuscript. NSO and CTDD gave inputs to the manuscript. All were involved in the care of the patient being presented here and gave valuable inputs during the decision-making process. All approved the final version of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.