Type 1 diabetes mellitus presenting as distal renal tubular acidosis (type 1)
Keywords:Type 1 diabetes mellitus, Ketonuria, Distal renal tubular acidosis, Diabetic ketoacidosis, Nephrocalcinosis
A 42 year-old male patient known case of type 1 diabetes mellitus for last 15 years got admitted with bilateral lower limb swelling and poorly controlled diabetes. He was found to have alkaline urinary pH, persistent metabolic acidosis even after the correction of blood sugars without ketonuria or diabetic ketoacidosis and nephrocalcinosis thus he was diagnosed as distal renal tubular acidosis (RTA Type 1) and managed by alkali replacement with blood sugar control. The association of type-1 diabetes mellitus with type-1 RTA has been rarely reported in the literature, but there are various case reports which had linked with distal RTA with autoimmunity and destruction of DCT. As our case which was unusual as every type-1 diabetes doesn’t have acidosis due to DKA focused research is required in this field.
Atkinson MA, Eisenbarth GS, Michels AW. Type 1 diabetes. Lancet. 2014;383(9911):69-82.
Both T, Zietse R, Hoorn EJ, van Hagen PM, Dalm VA, van Laar JA, van Daele PL. Everything you need to know about distal renal tubular acidosis in autoimmune disease. Rheumatol Int. 2014;34(8):1037-45.
Barker JM. Clinical review: Type 1 diabetes-associated autoimmunity: natural history, genetic associations, and screening. J Clin Endocrinol Metab. 2006;91(4):1210-7.
Dabelea D, Mayer-Davis EJ, Saydah S, Imperatore G, Linder B, Divers J, et al. Search for Diabetes in Youth Study. Prevalence of type 1 and type 2 diabetes among children and adolescents from 2001 to 2009. J Am Med Assoc. 2014;311(17):1778-86.
Hess B (2006) Acid–base metabolism: implications for kidney stones formation. Urol Res. 2006;34(2):134–8.
Arampatzis S, Röpke-Rieben B, Lippuner K, Hess B. Prevalence and densitometric characteristics of incomplete distal renal tubular acidosis in men with recurrent calcium nephrolithiasis. Urol Res. 2012;40(1):53-9.
Batlle DC, Sehy JT, Roseman MK, Arruda JA, Kurtzman NA. Clinical and pathophysiologic spectrum of acquired distal renal tubular acidosis. Kidney Int. 1981;20(3):389-96.
Konishi K, Hayashi M, Saruta T. Renal tubular acidosis with autoantibody directed to renal collecting-duct cells. N Engl J Med. 1994;331(23):1593-4.
Maeng M, Pedersen KM. A young woman with metabolic acidosis and recently discovered IDDM without ketouria. A rare autoimmune (?) combination of hypothyroidism, diabetes mellitus and distal tubular acidosis. Ugeskr Laeger. 1998;21;160:5663–566-4.
Raddatz V, Alvo M, Durruty P, Orellana L, Garcia de los Rios M. Decompensated diabetes mellitus and hyperchloremic metabolic acidosis: a case with both pathologies. Rev Med Chil. 1998;126:1224-8.
Dymot JA, McKay GA. Type 1 (distal) renal tubular acidosis in a patient with Type 1 diabetes mellitus--not all cases of metabolic acidosis in Type 1 diabetes mellitus are due to diabetic ketoacidosis. Diabet Med. 2008;25(1):114-5.
Gilbert RE, Cooper ME. The tubulointerstitium in progressive diabetic kidney disease: more than an aftermath of glomerular injury? Kidney Int. 1999;56(5):1627-37.
Magri CJ, Fava S. The role of tubular injury in diabetic nephropathy. Eur J Intern Med. 2009;20(6):551-5.
Zeni L, Norden AGW, Cancarini G, Unwin RJ. A more tubulocentric view of diabetic kidney disease. J Nephrol. 2017;30(6):701-17.