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        "resumen" => "Sr&#46; Director&#58; La acidosis tubular renal &#40;ATR&#41; se define como la incapacidad del tubulo renal de acidificar la orina independientemente de cualquier reducci&#243;n en el &#237;ndice de filtraci&#243;n glomerular&#46; Un subtipo es la ATR tipo I o distal que se caracteriza por la alteraci&#243;n en la secreci&#243;n de hidrogeniones &#40;H&#43;&#41; en el tubulo contorneado distal&#46; Este defecto puede ser hereditario o adquirido y resulta en la retenci&#243;n de H&#43;&#44; con la consiguiente disminuci&#243;n del bicarbonato plasm&#225;tico y una orina alcalina1&#44; 2&#46; Las causas m&#225;s comunes de ATR I son la diabetes mellitus&#44; el sindrome de Sj&#246;gren&#44; el mieloma m&#250;ltiple&#44; la amiloidosis primaria&#44; la sarcoidosis&#44; el transplante renal&#44; la uropat&#237;a obstructiva&#44; la enfermedad de c&#233;lulas falciformes&#44; los trastornos del metabolismo del calcio&#44; y ciertas drogas 1&#44; 2&#46;"
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Hypokalemia, distal renal tubular acidosis, and Hashimoto's thyroiditis
Hipokalemia, acidosis tubular distal y tiroiditis de Hashimoto
Bárbara Finna, Pablo Younga, Julio E Bruetmana, Mariano Forresterb, Fernando Lombib, Vicente Campolo Girardb, Horacio Pereyrab, Hernán Trimarchib
a Servicio de Clínica Médica Hospital Británico de Buenos Aires, Buenos Aires, Buenos Aires, Argentina,
b Servicio de Nefrología, Hospital Británico de Buenos Aires, Buenos Aires, Buenos Aires, Argentina,
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    "textoCompleto" => "To the editor&#58; Renal tubular acidosis &#40;RTA&#41; is defined as the inability of renal tubule to acidify urine regardless of any reduction in glomerular filtration rate&#46; Type I or distal RTA is a subtype characterized by an impaired hydrogen <br></br>ion &#40;H&#43;&#41; secretion in the distal convoluted tubule&#46; This defect may be inherited or acquired&#44; and causes H&#43; retention&#44; with the resultant decrease in plasma bicarbonate and alkaline urine&#46;1&#44;2 Most common cause of RTA I include diabetes mellitus&#44; Sj&#246;gren&#191;s syndrome&#44; multiple myeloma&#44; primary amyloidosis&#44; sarcoidosis&#44; kidney transplant&#44; obstructive uropathy&#44; sickle cell disease&#44; calcium metabolism disorders&#44; and certain drugs&#46;1&#44;2 <br></br><br></br>Thyroid hormone increases membrane cell Na&#43;&#44; K&#43;-ATPase pumps&#46;3 In hypothyroidism&#44; content and function of these pumps are reduced&#44; which causes a decreased elimination of H&#43;&#44; exacerbating the acidotic state caused by RTA&#46; Hypocalcemia in hypothyroid patients is caused by type I RTA&#46;3-6 <br></br><br></br>Two patients with hypocalcemia due to renal tubular acidosis secondary to Hashimoto&#191;s thyroiditis are reported below&#46; We suggest that this association is mediated by autoimmune mechanisms&#46; <br></br><br></br>PATIENT 1 <br></br>A 29-year-old female patient with progressive muscle weakness and quadriplegia&#44; hyperchloremic metabolic acidosis with normal anion gap&#44; and severe hypokalemia&#44; which was corrected with intravenous potassium with clinical improvement&#46; RTA type I&#44; with high titers of anti-peroxidase antibodies &#40;100 U&#47;mL&#41; and &#62; 100 mU&#47;mL of thyroid-stimulating hormone &#40;TSH&#41;&#44; was diagnosed&#46; Despite adequate alkali administration&#44; acid-base status was corrected when thyroid function was normalized&#46; After treatment with levothyroxin and potassium citrate&#44; the patient has been asymptomatic for the past 8 years&#46; <br></br><br></br>PATIENT 2 <br></br>A 30-year-old female patient with growth retardation due to type I RTA diagnosed in adolescence was admitted to hospital for a spontaneous hip fracture&#46; Patient reported marked fatigue&#44; weakness &#40;quadriparesis&#41;&#44; and muscle <br></br>cramps for the past two years&#46; Laboratory tests results&#58; TSH &#62; 100 mU&#47;mL&#44; high titers of anti-peroxidase antibodies <br></br>&#40;300 U&#47;mL&#41;&#44; and low free thyroxin levels &#40;table&#41;&#46; Treatment was started with levothyroxin 150 mg&#47;day and calcium <br></br>citrate&#46; Densitometry showed severe osteoporosis&#46; Patient has not relapsed after 7 years of hormone replacement <br></br>therapy&#46; <br></br><br></br>Hashimoto&#191;s thyroiditis is an autoimmune disease&#44; and type I RTA has also been related to autoimmunity&#46;6-8 Antibodies directed against collecting tubule cells could play an outstanding role in this setting&#44; affecting acid-base status and potassium balance&#46; These are the first cases reported in the literature of hypokalemic paralysis caused by type I RTA as a presentation form of Hashimoto&#191;s thyroiditis&#46; <br></br><br></br>Taking into account that Hashimoto&#191;s thyroiditis is the most common cause of hypothyroidism&#44; with a 1&#37; prevalence&#44; type I RTA could be an underdiagnosed associated condition with variable grades of clinical expressivity&#46; "
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        "resumen" => "Sr&#46; Director&#58; La acidosis tubular renal &#40;ATR&#41; se define como la incapacidad del tubulo renal de acidificar la orina independientemente de cualquier reducci&#243;n en el &#237;ndice de filtraci&#243;n glomerular&#46; Un subtipo es la ATR tipo I o distal que se caracteriza por la alteraci&#243;n en la secreci&#243;n de hidrogeniones &#40;H&#43;&#41; en el tubulo contorneado distal&#46; Este defecto puede ser hereditario o adquirido y resulta en la retenci&#243;n de H&#43;&#44; con la consiguiente disminuci&#243;n del bicarbonato plasm&#225;tico y una orina alcalina1&#44; 2&#46; Las causas m&#225;s comunes de ATR I son la diabetes mellitus&#44; el sindrome de Sj&#246;gren&#44; el mieloma m&#250;ltiple&#44; la amiloidosis primaria&#44; la sarcoidosis&#44; el transplante renal&#44; la uropat&#237;a obstructiva&#44; la enfermedad de c&#233;lulas falciformes&#44; los trastornos del metabolismo del calcio&#44; y ciertas drogas 1&#44; 2&#46;"
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        "resumen" => "To the editor&#58; Renal tubular acidosis &#40;RTA&#41; is defined as the inability of renal tubule to acidify urine regardless of any reduction in glomerular filtration rate&#46; Type I or distal RTA is a subtype characterized by an impaired hydrogen ion &#40;H&#43;&#41; secretion in the distal convoluted tubule&#46; This defect may be inherited or acquired&#44; and causes H&#43; retention&#44; with the resultant decrease in plasma bicarbonate and alkaline urine&#46;1&#44;2 Most common cause of RTA I include diabetes mellitus&#44; Sj&#246;gren&#191;s syndrome&#44; multiple myeloma&#44; primary amyloidosis&#44; sarcoidosis&#44; kidney transplant&#44; obstructive uropathy&#44; sickle cell disease&#44; calcium metabolism disorders&#44; and certain drugs&#46;1&#44;2 "
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