RENAL TUBULAR-ACIDOSIS PRECEDING SYSTEMIC LUPUS-ERYTHEMATOSUS

A 10-year-old girl with distal renal tubular acidosis (RTA) for 4 year s (adequately treated for 3 years) developed clinical features suggest ing systemic lupus erythematosus (SLE) with supportive laboratory evid ence. She had heavy proteinuria and a decreased creatinine clearance ( C-Cr). Renal biopsy showed diffuse proliferative and sclerosing glomer ulonephritis with severe tubulointerstitial changes. Following treatme nt with corticosteroids and cyclophosphamide, she had a clinical remis sion, an increase in C-Cr and recovery from systemic acidosis. It is L ikely that distal RTA in this patient was a manifestation of SLE.