Abstract: SA-PO516
Worsening of Distal Renal Tubular Acidosis (dRTA) as a Sign of Recurrent Autoimmune Hepatitis after Liver Transplant
Session Information
- Acid-Base, Calcium, Potassium, and Magnesium Disorders: Clinical
October 26, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Fluid, Electrolytes, and Acid-Base Disorders
- 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical
Authors
- Elshouny, Samir Abdellatif, King Faisal Specialist Hospital and Research Centre, Riyadh, Riyadh, Saudi Arabia
- Al saeed, Ayat Salman, Royal Commission for Jubail and Yanbu, Jubail, Saudi Arabia
- Elfar, Ahmed F., King Faisal Specialist Hospital and Research Centre, Riyadh, Riyadh, Saudi Arabia
Introduction
dRTA is characterized by hyperchloremic non-anion gap metabolic acidosis, marked hypokalemia and alkaline urine. Patients with dRTA almost always have hypocitraturia which increase the risk of calcium phosphate stones and nephrocalcinosis. dRTA develops because of autoimmune diseases including Sjögren's syndrome, autoimmune hepatitis and other causes.
Case Description
A 32 years old female with a history of autoimmune hepatitis complicated with cirrhosis underwent living related liver transplant. Her family history was negative for any autoimmune diseases. Few years prior to liver transplant, she was diagnosed with dRTA secondary to autoimmune hepatitis. Her disease was complicated by kidney stones which required surgical removal.
Post-transplant, she has remained stable clinically and biochemically. 6 months after the transplant surgery, she presented to our hospital with fatigability, low energy, continuous vomiting, and poor appetite.
Blood pH 7.14. Serum creatinine 129 umol/L (close to baseline), K 2.9 mmol/l, HCO3 10 mmol/L. T.Bilirubin 216 umol/L, D.Bilirubin 187 umol/L, ALT 176 U/L, AST 156 U/L alk. phosphatase 323 U/L. Urine pH 7, urine K 8.55 mmol/L, urine creatinine 1.1 mmol/l. Urine K/C Ratio 7.77 mmol/mmol indicating renal potassium wasting.
MRCP showed focal biliary anastomotic stricture with minimal intrahepatic biliary dilatation. She underwent ERCP mediated dilatation and stenting. A biopsy of the liver was consistent with recurrent autoimmune hepatitis. The patient was discharged on steroid tapering dose and K citrate.
Discussion
We present a new correlation between worsening dRTA and recurrence of autoimmune hepatitis in a post liver transplant patient. Our case highlights that worsening dRTA could be a sign of recurrence of the primary disease in the transplant graft. To our knowledge, this finding has never been reported in the literature.