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=> "10.1016/j.nefro.2018.06.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699518301164?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251418301366?idApp=UINPBA000064" "url" => "/20132514/0000003800000006/v1_201812140610/S2013251418301366/v1_201812140610/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Distal renal tubular acidosis in two children with acquired hypothyroidism" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "655" "paginaFinal" => "659" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Norma E. Guerra-Hernández, Karen V. Ordaz-López, Rosa Vargas-Poussou, Laura Escobar-Pérez, Víctor M. García-Nieto" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Norma E." "apellidos" => "Guerra-Hernández" "email" => array:2 [ 0 => "nelizguerra@gmail.com" 1 => "normaegh@yahoo.com.mx" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Karen V." "apellidos" => "Ordaz-López" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Rosa" "apellidos" => "Vargas-Poussou" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Laura" "apellidos" => "Escobar-Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "Víctor M." "apellidos" => "García-Nieto" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología Pediátrica, Hospital General del Centro Médico Nacional «La Raza», Instituto Mexicano del Seguro Social (IMSS), Ciudad de México, Mexico" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Genética y Fisiología, Hospital Europeo Georges Pompidou, París, France" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departamento de Fisiología, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Sección de Nefrología Pediátrica, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Acidosis tubular renal distal en dos niñas diagnosticadas de hipotiroidismo adquirido" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 648 "Ancho" => 950 "Tamanyo" => 48830 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Ultrasound image of nephrocalcinosis in case 1.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The term renal tubular acidosis (RTA) is applied to a group of transport defects in the reabsorption of bicarbonate in the proximal tubule (proximal or type 2 RTA), the excretion of hydrogen ions (H<span class="elsevierStyleSup">+</span>) in the collecting tubule (RTA type 1 and 4) or both (RTA type 3).<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">1</span></a> It is characterised by the presence of persistent hyperchloraemic metabolic acidosis with a normal anion gap.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Primary forms are more common in infants and children.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">2</span></a> Distal RTA is the most common variant. In recent years, molecular biology techniques have identified the genetic factors involved in inadequate urinary excretion of H<span class="elsevierStyleSup">+</span> and ammonium in patients with distal RTA.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">3</span></a> This defect can be diagnosed by NH<span class="elsevierStyleInf">4</span>Cl loading (rich in H<span class="elsevierStyleSup">+</span>) or by determining maximum urinary pCO<span class="elsevierStyleInf">2</span> (UpCO<span class="elsevierStyleInf">2</span>).<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">4</span></a> Clinically, distal RTA is characterised by the presence of polyuria, polydipsia, nephrocalcinosis, hypokalaemia, persistently alkaline urine, hypercalciuria, hypocitraturia, and a defect in renal concentrating capacity, with a tendency towards dehydration.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Secondary forms of distal RTA, more common in adults, are associated with the administration of drugs or toxins, or with systemic or immunological diseases. In children, secondary causes are less common, and have been described in cases of Sjögren's syndrome<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">6</span></a> or systemic lupus erythematosus,<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">7</span></a> or after oral intake of some medications.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Few cases of distal RTA associated with classic hypothyroidism or with autoimmune thyroid disease have been reported. Even fewer cases have been reported in children. We report the cases of two girls with acquired hypothyroidism associated with secondary distal RTA. The association between hypothyroidism and type 3 RTA in one of the patients is the first case reported in the literature.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Case 1</span><p id="par0025" class="elsevierStylePara elsevierViewall">A girl aged 5 years and 7 months, with a history of abdominal distension from the first months of life, together with arrested weight gain and growth from the age of 2 (below the 3rd percentile). She was admitted due to a 3-day history of fever of 39<span class="elsevierStyleHsp" style=""></span>°C, greenish rhinorrhoea, productive cough and pharyngeal pain, accompanied by progressive respiratory difficulty, polypnoea and abdominal distension. On admission, the physical examination found severe dehydration, dry oral mucosa, tachycardia, signs of pulmonary consolidation in the right hemithorax, and distended abdomen with decreased peristalsis. A chest X-ray confirmed the diagnosis of pneumonia, and an abdominal X-ray was compatible with metabolic ileus. Laboratory test findings included metabolic acidosis, hyperchloraemia and hypokalaemia, which persisted despite restoration of the fluid balance (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). A urine test found hypercalciuria and hypocitraturia (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>) and the kidney ultrasound showed grade 2 nephrocalcinosis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). An acetazolamide- and sodium bicarbonate-loading test was performed, obtaining a maximum urinary pCO<span class="elsevierStyleInf">2</span> of 47<span class="elsevierStyleHsp" style=""></span>mmHg at 60<span class="elsevierStyleHsp" style=""></span>min (urine-blood pCO<span class="elsevierStyleInf">2</span> gradient: 15<span class="elsevierStyleHsp" style=""></span>mmHg) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). The audiometry test was normal.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">After reaching a diagnosis of distal RTA, treatment with potassium citrate solution was initiated (4<span class="elsevierStyleHsp" style=""></span>mEq/kg/day), with no improvement in weight and height, and persistence of asthenia, adynamia and somnolence. The thyroid function test showed thyroid-stimulating hormone (TSH) levels of more than 150<span class="elsevierStyleHsp" style=""></span>mU/l, T3 levels of 0.19<span class="elsevierStyleHsp" style=""></span>ng/ml and undetectable T4. Blood samples were positive for antithyroglobulin (181.6<span class="elsevierStyleHsp" style=""></span>IU/ml) and antiperoxidase (373.2<span class="elsevierStyleHsp" style=""></span>IU/ml) antibodies. Levothyroxine was started, and the patient's weight and height improved. Now, at 11 years of age, her weight is 29<span class="elsevierStyleHsp" style=""></span>kg (p8%) and her height 133<span class="elsevierStyleHsp" style=""></span>cm (p6%); urinary acidification defect persists (maximum urinary pCO<span class="elsevierStyleInf">2</span> of 49<span class="elsevierStyleHsp" style=""></span>mmHg).</p><p id="par0035" class="elsevierStylePara elsevierViewall">No molecular alterations were observed in <span class="elsevierStyleItalic">ATP6V0A4</span>, <span class="elsevierStyleItalic">ATP6V1B1</span> and <span class="elsevierStyleItalic">SLC4A1</span> genes analysed by targeted exon and exon-intron transition sequencing.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case 2</span><p id="par0040" class="elsevierStylePara elsevierViewall">This was a 13-year-old girl, with no significant family history, with arrested weight gain and growth from the age of 7. Since then, she had presented 4 episodes of limb paralysis and generalised weakness, with craniocervical instability and bilateral genu valgum. At age 11 she was diagnosed with hypothyroidism, and started treatment with levothyroxine. She was subsequently referred to the hospital for a hypokalaemia study. The results of the blood and urine panels and acidification test are shown in <a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1 and 2</a>. Along with the distal acidification defect, a bicarbonate leak in the proximal tubule, compatible with type 3 RTA was observed (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Kidney ultrasound showed bilateral grade 2 nephrocalcinosis. The audiometry assessment was normal. Blood samples were positive for antithyroglobulin (246.8<span class="elsevierStyleHsp" style=""></span>IU/ml) and antiperoxidase (92.6<span class="elsevierStyleHsp" style=""></span>IU/ml) antibodies. One year after the diagnosis of RTA, the patient required higher doses of citrate, and the urinary acidification defect (maximum urinary pCO<span class="elsevierStyleInf">2</span> of 53<span class="elsevierStyleHsp" style=""></span>mmHg) persists. Now, at 14 years of age, she weighs 40<span class="elsevierStyleHsp" style=""></span>kg (p5%) and her height is 138<span class="elsevierStyleHsp" style=""></span>cm (p0%).</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0045" class="elsevierStylePara elsevierViewall">Thyroid hormones influence kidney development, kidney structure, renal haemodynamics, glomerular filtration rate, the function of many transport systems along the nephron, in particular those related to the management of sodium, acid–base balance and renal concentrating capacity. These effects of the thyroid hormone are in part due to direct renal actions, and in part to cardiovascular and systemic haemodynamic effects that influence kidney function.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">8</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Thyroid hormones directly influence the expression and/or activity of a number of ion channels and transporters. Pioneering micropuncture studies in hypothyroid rats have shown a reduction in the renal glomerular filtration rate (GFR) and an increase in the urinary excretion of sodium and water.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">9</span></a> A subsequent study reported that the thyroid hormone regulates the activity of the proximal tubular type 3 Na<span class="elsevierStyleSup">+</span>/H<span class="elsevierStyleSup">+</span> exchanger (NHE3)<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">10</span></a> (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), an effect that is due to direct binding of the hormone with the promoter region of the encoding gene.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">11</span></a></p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">A study published in 2007 confirmed the activity of several transporters involved in sodium and acid–base balance in rats rendered hypothyroid by the administration of methimazole.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">12</span></a> The results obtained are summarised in the footer of <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>. Basically, the activity of several proximal tubule transporters is reduced, which results in a loss of sodium and a reduction in the elimination of hydrogen ions at this level, while expression of the Cl<span class="elsevierStyleSup">−</span>/HCO<span class="elsevierStyleInf">3</span><span class="elsevierStyleSup">−</span> (AE1) exchanger specific to α-intercalated cells of the connecting tubule and cortical collecting duct increases.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">12</span></a> This shows, therefore, that thyroid hormone deficiency is associated with a defect in the renal handling of sodium and of the acid–base balance, which is mainly located in the proximal tubule and is compensated by the distal nephron. Consequently, on a physiological level, the thyroid hormone modulates the renal response to acid overload and alters the expression of several transporters that are key in the maintenance of the acid–base balance.</p><p id="par0060" class="elsevierStylePara elsevierViewall">This begs the question of why significant proximal sodium loss does not lead to reduced levels of sodium in hypothyroidism. This was studied in transgenic mice deficient in the Na<span class="elsevierStyleSup">+</span>/H<span class="elsevierStyleSup">+</span> (NHE3) exchanger<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">13</span></a> and in adults with mutations in the encoding gene.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">14</span></a> In these cases, loss of NHE3 was compensated by a reduction in GFR caused by adenosine-induced vasoconstriction of the afferent arteriole. This is one of the reasons why GFR is reduced in hypothyroid patients.<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">15,16</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">A study published in the 1970s showed that 2 of 5 adults with primary hypothyroidism without metabolic acidosis and with no clinical evidence of autoimmune disease were unable to lower their urine pH appropriately after short duration acid-loading<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">17</span></a>; this is typical of incomplete distal RTA. Subsequently, various cases of type 1 RTA have been described in adults with non-autoimmune hypothyroidism.<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">18,19</span></a> One of these patients presented with hyperkalaemia (type 4 RTA) compatible with an increase in Na<span class="elsevierStyleSup">+</span> levels in the tubular lumen of the collecting duct and impaired distal secretion due to an H<span class="elsevierStyleSup">+</span> and K<span class="elsevierStyleSup">+18</span> gradient defect.</p><p id="par0070" class="elsevierStylePara elsevierViewall">However, most patients with both clinical conditions presented autoimmune hypothyroidism. This combination has been described both in adults<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">20–22</span></a> and children<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">23,24</span></a>; in one of these cases of RTA, serum levels of T3, T4 and TSH were normal,<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">22</span></a> supporting the notion that, as in other autoimmune diseases, antithyroid antibodies can <span class="elsevierStyleItalic">per se</span> can have a negative effect on renal acidification capacity.<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">6,7</span></a> There are several references in the literature to the triple association of RTA, hypothyroidism and another autoimmune disease such as diabetes mellitus<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">25</span></a> or Sjögren's syndrome.<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">26,27</span></a> The fact that our second case was diagnosed with RTA 2 years after starting treatment with thyroid hormone supports the hypothesis that antithyroid antibodies have a negative effect on renal acidification capacity, although poor compliance with replacement treatment cannot be entirely ruled out. The pathophysiological mechanism of distal RTA associated with autoimmune disease is not well understood. In patients with Sjögren's syndrome, immunohistochemical studies have shown the absence of vacuolar H<span class="elsevierStyleSup">+</span>-ATPase in collecting duct cells obtained from renal biopsies.<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">28</span></a> More recently, in the same disease, autoantibodies against carbonic anhydrase II enzymes have been described (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">29</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">The test used to determine maximum urinary pCO<span class="elsevierStyleInf">2</span> in both our patients is a variant of the one previously described by our Group. In this challenge, acetazolamide and sodium bicarbonate are administered simultaneously at lower doses than usual, thus obtaining valid results (urinary HCO<span class="elsevierStyleInf">3</span><span class="elsevierStyleSup">−</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>80<span class="elsevierStyleHsp" style=""></span>mEq/l) while avoiding significant side effects.<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">4,30,31</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The loss of proximal bicarbonate reported in case 2 must be associated with a reduction in the activity of both the Na<span class="elsevierStyleSup">+</span>/H<span class="elsevierStyleSup">+</span> exchanger (NHE3) and the Na<span class="elsevierStyleSup">+</span>/HCO<span class="elsevierStyleInf">3</span><span class="elsevierStyleSup">−</span> (NBCe1) cotransporter, as described above (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">12</span></a> However, being a type 3 RTA (proximal and distal) the patient could, theoretically, be a carrier of autoantibodies against carbonic anhydrase II, which is functional in both the proximal and distal portions of the nephron.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres1127261" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1060980" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1127262" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1060981" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Case 1" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case 2" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflicts of interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-08-19" "fechaAceptado" => "2017-12-31" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1060980" "palabras" => array:4 [ 0 => "Renal tubular acidosis" 1 => "Hypothyroidism" 2 => "Autoimmunity" 3 => "Maximum urinary pCO<span class="elsevierStyleInf">2</span>" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1060981" "palabras" => array:4 [ 0 => "Acidosis tubular renal" 1 => "Hipotiroidismo" 2 => "Autoinmunidad" 3 => "pCO<span class="elsevierStyleInf">2</span> urinaria máxima" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Two cases of children diagnosed with renal tubular acidosis (RTA) associated with autoimmune hypothyroidism are presented.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Case 1 developed an intestinal ileus at the age of five in the context of a respiratory problem. The tests performed confirmed metabolic acidosis, hyperchloraemia, hypokalaemia and nephrocalcinosis. Case 2 was diagnosed with hypothyroidism at the age of 11, and with RTA two years later.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">In both patients, the diagnosis of RTA was verified when decreased maximum urinary pCO<span class="elsevierStyleInf">2</span> was found. In case 2, a proximal bicarbonate leak (type 3 RTA) was also confirmed. This was the first case to be published on the topic.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The causes of RTA in patients with hypothyroidism are reviewed. The deleterious effect on the kidneys may be due to the absence of thyroid hormone and/or autoantibodies in the cases of autoimmune hypothyroidism.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Se presentan dos casos en edad pediátrica diagnosticados de acidosis tubular renal (ATR) asociada a hipotiroidismo de causa autoinmune.</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El caso 1 desarrolló un íleo intestinal a los 5 años de edad en el seno de un problema respiratorio. En los exámenes realizados se constató acidosis metabólica, hipercloremia, hipopotasemia y nefrocalcinosis. El caso 2 fue diagnosticado de hipotiroidismo a los 11 años de edad y 2 años después, de ATR.</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">En ambos pacientes, se comprobó el diagnóstico de ATR al observarse una pCO<span class="elsevierStyleInf">2</span> urinaria máxima reducida. En el caso 2 se constató, además, una fuga proximal de bicarbonato (ATR tipo 3), que constituye el primer caso publicado sobre el tema.</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se revisan las causas de ATR en pacientes con hipotiroidismo. El efecto deletéreo sobre el riñón puede ser debido a la propia ausencia de hormona tiroidea y/o a los autoanticuerpos en los casos de hipotiroidismo autoinmune.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Guerra-Hernández NE, Ordaz-López KV, Vargas-Poussou R, Escobar-Pérez L, García-Nieto VM. Acidosis tubular renal distal en dos niñas diagnosticadas de hipotiroidismo adquirido. Nefrologia. 2018;38:655–659.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 648 "Ancho" => 950 "Tamanyo" => 48830 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Ultrasound image of nephrocalcinosis in case 1.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1735 "Ancho" => 2144 "Tamanyo" => 157956 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The expression of the Na<span class="elsevierStyleSup">+</span>/H<span class="elsevierStyleSup">+</span> exchanger (NHE3), the Na+-phosphate cotransporter NaPi-IIa, and the B2 subunit of the vacuolar H<span class="elsevierStyleSup">+</span>-ATPase (not shown here) is reduced in the brush-border membrane of the proximal tubule in hypothyroid rats. This is accompanied by a lower abundance of the Na<span class="elsevierStyleSup">+</span>/HCO<span class="elsevierStyleInf">3</span><span class="elsevierStyleSup">−</span> cotransporter (NBCe1) and a higher expression of the acid-secretory type A intercalated cell-specific Cl<span class="elsevierStyleSup">−</span>/HCO<span class="elsevierStyleInf">3</span><span class="elsevierStyleSup">−</span> exchanger (AE1) in the connecting tubule and cortical collecting duct. NBCe1 expression and the number of α-intercalated cells increased in hypothyroid rats during metabolic acidosis.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">12</span></a> ACII: carbonic anhydrase II.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Case 1 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Case 2 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Venous blood gas</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>pH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>HCO<span class="elsevierStyleInf">3</span><span class="elsevierStyleSup">−</span> (mEq/l) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Serum chlorine (mmol/l)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">125 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">116 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Serum potassium (mmol/l)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Serum uric acid, (mg/dl)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Calcium/creatinine ratio (mg/mg)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.95 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.33 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">24-Hour urine calcium</span> (mg/kg/day) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Citrate/creatinine ratio (mg/mg)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">24-Hour urine citrate</span> (mg/kg/day) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Oxaluria (mmol/mol)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Fractional excretion of bicarbonate</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.39% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.75% \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1921411.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Blood and urine biochemical tests.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Case 1 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Case 2 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Urinary pH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Maximum urinary pCO<span class="elsevierStyleInf">2</span> (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Urinary HCO<span class="elsevierStyleInf">3</span><span class="elsevierStyleSup">−</span> (mEq/l) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">85.22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">101.97 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Urine-blood pCO<span class="elsevierStyleInf">2</span> gradient (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1921412.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Results of the maximum urinary pCO<span class="elsevierStyleInf">2</span> test performed after sodium bicarbonate and acetazolamide loading.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:31 [ 0 => array:3 [ "identificador" => "bib0160" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Renal tubular acidosis: the clinical entity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. 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Year/Month | Html | Total | |
---|---|---|---|
2024 November | 8 | 7 | 15 |
2024 October | 46 | 46 | 92 |
2024 September | 61 | 32 | 93 |
2024 August | 69 | 91 | 160 |
2024 July | 53 | 35 | 88 |
2024 June | 91 | 52 | 143 |
2024 May | 57 | 40 | 97 |
2024 April | 63 | 40 | 103 |
2024 March | 50 | 36 | 86 |
2024 February | 70 | 59 | 129 |
2024 January | 44 | 33 | 77 |
2023 December | 107 | 30 | 137 |
2023 November | 66 | 39 | 105 |
2023 October | 57 | 37 | 94 |
2023 September | 70 | 48 | 118 |
2023 August | 95 | 30 | 125 |
2023 July | 107 | 34 | 141 |
2023 June | 88 | 25 | 113 |
2023 May | 78 | 39 | 117 |
2023 April | 72 | 28 | 100 |
2023 March | 106 | 34 | 140 |
2023 February | 63 | 20 | 83 |
2023 January | 91 | 30 | 121 |
2022 December | 92 | 52 | 144 |
2022 November | 82 | 43 | 125 |
2022 October | 81 | 65 | 146 |
2022 September | 89 | 55 | 144 |
2022 August | 82 | 46 | 128 |
2022 July | 71 | 48 | 119 |
2022 June | 78 | 58 | 136 |
2022 May | 77 | 27 | 104 |
2022 April | 100 | 44 | 144 |
2022 March | 115 | 51 | 166 |
2022 February | 142 | 51 | 193 |
2022 January | 113 | 53 | 166 |
2021 December | 105 | 52 | 157 |
2021 November | 105 | 45 | 150 |
2021 October | 123 | 48 | 171 |
2021 September | 57 | 41 | 98 |
2021 August | 81 | 62 | 143 |
2021 July | 66 | 34 | 100 |
2021 June | 68 | 20 | 88 |
2021 May | 71 | 61 | 132 |
2021 April | 203 | 144 | 347 |
2021 March | 112 | 39 | 151 |
2021 February | 122 | 35 | 157 |
2021 January | 55 | 32 | 87 |
2020 December | 66 | 16 | 82 |
2020 November | 41 | 23 | 64 |
2020 October | 66 | 37 | 103 |
2020 September | 66 | 28 | 94 |
2020 August | 46 | 14 | 60 |
2020 July | 47 | 16 | 63 |
2020 June | 54 | 29 | 83 |
2020 May | 58 | 17 | 75 |
2020 April | 57 | 20 | 77 |
2020 March | 49 | 29 | 78 |
2020 February | 39 | 24 | 63 |
2020 January | 69 | 34 | 103 |
2019 December | 68 | 41 | 109 |
2019 November | 64 | 45 | 109 |
2019 October | 43 | 20 | 63 |
2019 September | 44 | 26 | 70 |
2019 August | 32 | 29 | 61 |
2019 July | 25 | 35 | 60 |
2019 June | 26 | 30 | 56 |
2019 May | 30 | 36 | 66 |
2019 April | 57 | 72 | 129 |
2019 March | 34 | 36 | 70 |
2019 February | 28 | 25 | 53 |
2019 January | 30 | 34 | 64 |
2018 December | 64 | 51 | 115 |