Renal Tubular Acidosis with Autoantibody Directed to Renal Collecting-Duct Cells

To the Editor: Although distal renal tubular acidosis is often associated with immune-mediated diseases, autoantibodies against renal tubular cells have been detected only sporadically.¹–³ We report the case of a 34-year-old woman with Graves' hyperthyroidism and distal renal tubular acidosis whose serum contained antibodies to renal collecting-duct cells. In August 1989 weight loss and palpitation occurred in the patient. She had exophthalmos, diffuse goiter, and elevated serum thyroid hormone concentrations. She was treated with methimazole and became euthyroid. In June 1991 progressive weakness of the extremities developed over a period of several days. The patient was taking 2.5 mg…