UROLITHIASIS AND DISTAL RENAL TUBULAR-ACIDOSIS PRECEDING PRIMARY SJOGRENS-SYNDROME - A RETROSPECTIVE STUDY 5-53 YEARS AFTER THE PRESENTATION OF UROLITHIASIS

Objectives. Distal renal tubular acidosis (dRTA) can be associated wit h autoimmune diseases such as primary Sjogren's syndrome (SS), Our obj ective was to study SS-associated symptoms, autoantibodies and renal h istopathology in patients with urolithiasis and dRTA. Setting. The pat ients were from the Departments of Nephrology and Rheumatology, Univer sity Hospital of Linkoping, which is a tertiary referral hospital, as well as a secondary referral centre for the immediate area around the city of Linkoping. Subjects. Ten female patients with dRTA, who presen ted with urolithiasis and not with subjective sicca symptoms, were fro m the Department of Nephrology, University Hospital, Linkoping. Autoan tibodies were detected in eight of these patients, and they were studi ed with respect to clinical and laboratory evidence of SS (urolithiasi s group). Fifteen women with SS, who presented with sicca symptoms and not with urolithiasis or dRTA, served as the reference group. Results . In the urolithiasis group, all of the eight patients had anti-SS-A a ntibodies, and SS (or possible SS) developed in seven of the eight pat ients 1-48 (mean 15) years after the onset of urolithiasis. Histologic al features of tubulointerstitial nephritis were found in four of five biopsied patients in the urolithiasis group, and in two of four patie nts (with dRTA) in the reference group. Conclusions. Urolithiasis and dRTA can precede subjective sicca symptoms, and patients with dRTA may have SS in the absence of subjective sicca symptoms. Anti-SS-A antibo dies are common in patients with urolithiasis and dRTA. Therefore, we hypothesize the possibility of a Sjogren-related renal disease in thes e patients.