{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T04:05:52Z","timestamp":1789704352552,"version":"4.0.1"},"reference-count":49,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2022,11,2]],"date-time":"2022-11-02T00:00:00Z","timestamp":1667347200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J of Rheum Dis"],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>To describe the clinical and laboratory features of Sj\u00f6gren's syndrome (SS) with renal tubular acidosis (RTA) from published literature.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A systematic search of indexed publications in all languages till December 2021 identified cases of SS with RTA (SS\u2010RTA) and were included if either antibody (anti\u2010SSA\/anti\u2010SSB) or salivary gland histopathology were positive.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 440 cases of SS\u2010RTA (63.9% from Asia, 95.5% women). The median (range) age was 37 (6\u201078) years. Only 7.7% had a previous diagnosis of SS. Oral or ocular sicca symptoms were present in 63.7%. Positive ocular tests, oral tests, anti\u2010SSA, anti\u2010SSB and salivary gland histopathology were reported in 256\/331 (77.3%), 123\/128 (96%), 382\/407 (93.9%), 298\/379 (78.6%), and 246\/268 (91.8%), respectively. Hypokalemic paralysis (HP) was the presenting feature in 63.6%; 25% had multiple episodes of HP and 8.4% had respiratory paralysis. Type 1, type 2, combined type 1 &amp; 2, and type 4 RTA was seen in 388, 8, 38, and 3 patients, respectively. Proximal dysfunction and RTA complications were infrequently evaluated. Fanconi syndrome, nephrogenic diabetes insipidus, proteinuria, and low estimated glomerular filtration rate were found in 45, 21, 178, and 157, respectively. Nephrocalcinosis, renal stones, and osteomalacia were reported in 92, 79, and 72, respectively. Tubulointerstitial nephritis was found in 142 out of 152 renal biopsies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>SS\u2010RTA is an early manifestation of SS characterized by younger age and subclinical sicca symptoms. Although evaluated less frequently, oral sicca signs and salivary gland biopsy have a high positive yield. HP is the most common presentation. RTA is mostly distal; proximal dysfunction and complications were infrequently assessed.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1756-185x.14483","type":"journal-article","created":{"date-parts":[[2022,11,3]],"date-time":"2022-11-03T04:24:46Z","timestamp":1667449486000},"page":"278-285","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Comprehensive analysis of clinical and laboratory features of 440 published cases of Sj\u00f6gren's syndrome and renal tubular acidosis"],"prefix":"10.1111","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9513-4535","authenticated-orcid":false,"given":"Pulukool","family":"Sandhya","sequence":"first","affiliation":[{"name":"Department of Rheumatology, St. Stephen's Hospital  Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,11,2]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(65)90057-4"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(70)90045-8"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780110607"},{"key":"e_1_2_7_5_1","first-page":"115","article-title":"Renal tubular acidosis: an immunopathological study on four patients","volume":"7","author":"Pasternack A","year":"1970","journal-title":"Clin Exp Immunol"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.3.5715.143"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40744-020-00264-x"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrneph.2015.174"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kev200"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.4103\/0022-3859.194224"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1159\/000365199"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.2174\/1874312901408010103"},{"key":"e_1_2_7_13_1","first-page":"69","article-title":"Clinical profile of primary Sjogrens syndrome with hypokalemic periodic paralysis","volume":"66","author":"Kulkarni N","year":"2018","journal-title":"J Assoc Physicians India"},{"key":"e_1_2_7_14_1","first-page":"11","article-title":"Hypokalemic paralysis due to primary Sj\u00f6gren's syndrome: case series","volume":"70","author":"Nahar N","year":"2022","journal-title":"J Assoc Physicians India"},{"key":"e_1_2_7_15_1","first-page":"3252","article-title":"Clinical and prognostic characteristics of 573 cases of primary Sj\u00f6gren's syndrome","volume":"123","author":"Lin DF","year":"2010","journal-title":"Chin Med J (Engl)"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000000667"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.2174\/1874312901409010036"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.7861\/clinmedicine.14-2-157"},{"key":"e_1_2_7_19_1","first-page":"278","article-title":"Renal involvement and followup of 130 patients with primary Sj\u00f6gren's syndrome","volume":"35","author":"Ren H","year":"2008","journal-title":"J Rheumatol"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/1756-185X.13429"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/16.12.2328"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/38.11.1113"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/93.5.297"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00296-018-4118-x"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keu401"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02207962"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02208028"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.5414\/CN108142"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.140.8.745"},{"key":"e_1_2_7_30_1","first-page":"525","article-title":"Review of the diagnostic evaluation of renal tubular acidosis","volume":"16","author":"Yaxley J","year":"2016","journal-title":"Ochsner J"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.61.6.554"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2016-210571"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10067-002-0671-4"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.5049\/KJEM.2003.1.1.55"},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.2169\/naika.69.1320"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40620-021-01184-x"},{"key":"e_1_2_7_37_1","first-page":"47","article-title":"Sjogren's syndrome with secondary tubular acidosis","volume":"34","author":"Pisanty S","year":"1979","journal-title":"J Oral Med"},{"key":"e_1_2_7_38_1","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2019-230402"},{"key":"e_1_2_7_39_1","doi-asserted-by":"publisher","DOI":"10.55563\/clinexprheumatol\/egnd1i"},{"key":"e_1_2_7_40_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kez578"},{"key":"e_1_2_7_41_1","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/94.3.133"},{"key":"e_1_2_7_42_1","doi-asserted-by":"publisher","DOI":"10.2169\/naika.69.1458"},{"key":"e_1_2_7_43_1","doi-asserted-by":"publisher","DOI":"10.2169\/naika.72.902"},{"key":"e_1_2_7_44_1","doi-asserted-by":"publisher","DOI":"10.2177\/jsci.9.433"},{"key":"e_1_2_7_45_1","doi-asserted-by":"publisher","DOI":"10.1136\/pgmj.75.882.193"},{"key":"e_1_2_7_46_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.40930"},{"key":"e_1_2_7_47_1","first-page":"259","article-title":"T lymphocyte subsets of the infiltrating cells in the salivary gland and kidney of a patient with Sj\u00f6gren's syndrome associated with interstitial nephritis","volume":"3","author":"Takaya M","year":"1985","journal-title":"Clin Exp Rheumatol"},{"key":"e_1_2_7_48_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0272-6386(88)80169-0"},{"key":"e_1_2_7_49_1","first-page":"335","article-title":"Immunohistochemical identification of infiltrating mononuclear cells in tubulointerstitial nephritis associated with Sj\u00f6gren's syndrome","volume":"30","author":"Matsumura R","year":"1988","journal-title":"Clin Nephrol"},{"key":"e_1_2_7_50_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00467-016-3573-4"}],"container-title":["International Journal of Rheumatic Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1756-185X.14483","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/1756-185X.14483","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1756-185X.14483","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,20]],"date-time":"2023-08-20T18:45:00Z","timestamp":1692557100000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/1756-185X.14483"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,2]]},"references-count":49,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2023,2]]}},"alternative-id":["10.1111\/1756-185X.14483"],"URL":"https:\/\/doi.org\/10.1111\/1756-185x.14483","archive":["Portico"],"relation":{},"ISSN":["1756-1841","1756-185X"],"issn-type":[{"value":"1756-1841","type":"print"},{"value":"1756-185X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,2]]},"assertion":[{"value":"2022-05-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-10-10","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-11-02","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}