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Secondary distal renal tubular acidosis and sclerotic metabolic bone disease in seronegative spondyloarthropathy
  1. Neeti Agrawal1,
  2. Rahin Mahata1,
  3. Partha Pratim Chakraborty1 and
  4. Kaushik Basu2
  1. 1Endocrinology & Metabolism, Medical College and Hospital Kolkata, Kolkata, West Bengal, India
  2. 2General Medicine & Rheumatology, Medical College and Hospital Kolkata, Kolkata, West Bengal, India
  1. Correspondence to Dr Partha Pratim Chakraborty; docparthapc{at}


Adults with distal renal tubular acidosis (dRTA) commonly present with hypokalaemia (with/without paralysis), nephrolithiasis/nephrocalcinosis and vague musculoskeletal symptoms. All adults with dRTA should be thoroughly evaluated for systemic diseases, certain medications and toxins. The leading cause of acquired or secondary dRTA in adults is primary Sjögren syndrome (SS); however, other collagen vascular diseases (CVDs) including seronegative spondyloarthropathy (SSpA) may at times give rise to secondary dRTA. Metabolic bone disease is often encountered in adults with dRTA, and the list includes osteomalacia and secondary osteoporosis; sclerotic metabolic bone disease is an extremely rare manifestation of dRTA. Coexistence of dRTA and sclerotic bone disease is seen in primary dRTA due to mutation in CA2 gene and acquired dRTA secondary to systemic fluorosis. Primary SS and SSpA, rarely if ever, may also lead to both secondary dRTA and osteosclerosis. Circulating autoantibodies against carbonic anhydrase II and possibly calcium sensing receptor may explain both these features in patients with CVD.

  • Calcium and bone
  • Musculoskeletal syndromes

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  • Contributors NA, RM, PPC and KB were involved in diagnosis and management of the patient. NA and RM did the literature search. NA and PPC wrote 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.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

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