TY - JOUR T1 - Renal tubular acidosis as the initial presentation of Sjögren’s syndrome JF - BMJ Case Reports JO - BMJ Case Reports DO - 10.1136/bcr-2019-230402 VL - 12 IS - 8 SP - e230402 AU - Karen Ho AU - Pouneh Dokouhaki AU - Mark McIsaac AU - Bhanu Prasad Y1 - 2019/08/01 UR - http://casereports.bmj.com/content/12/8/e230402.abstract N2 - We present a 44-year-old female with an initial presentation with distal renal tubular acidosis (RTA) after she presented with hypokalaemia and normal anion gap acidosis. Three years following the diagnosis, she presented with progressive renal impairment. In the absence of any clinical, biochemical and radiological clues, she underwent a renal biopsy which showed severe tubulitis secondary to lymphocytic infiltration. Serological investigations subsequently revealed positive anti-nuclear, anti-Sjögren’s syndrome related antigen A (SS-A), and anti-Sjögren’s syndrome related antigen B (SS-B) antibodies, supporting the diagnosis of Sjögren’s syndrome. This case is unique in that distal RTA was the presenting clinical manifestation of Sjögren’s syndrome. We hope that a consideration for Sjögren’s syndrome is made in patients with seemingly idiopathic RTA. ER -