The Case | Hypokalemia associated with nephrocalcinosis

A 43-year-old female was presented with general weakness. She had similar episodes of weakness and abnormal liver function test several times in the past, and hence diagnosed with hepatitis. Pertinent laboratory data were as follows: blood urea nitrogen 14.2 mg/100 ml, creatinine 0.8 mg/ 100 ml, potassium 3.6 mEq/l, serum osmolality 288 mOsmol/kg, urine osmolality 180 mOsmol/kg, random urine sodium 81 mEq/l, random urine potassium 25.9 mEq/l, random urine chloride 76 mEq/l. Aterial blood pH 7.24, pCO2 48.7 mm Hg, serum bicarbonate 20.5 mmol/l, urinary bicarbonate 6.2 mmol/l, urinary pH 7.0, plasma aldosterone 9.9 ng/100 ml, renin activity 4.9, aspartate aminotransferase 103 IU/l, alanine aminotransferase 250 IU/l, and total bilirubin 0.6 mg/100 ml. Antinuclear antibodies, antimitochondrial antibodies, anti-CCP, and anti-Ro/SS-A antibodies were positive. KUB (Figure 1a) and abdominal computed tomography (CT) (Figure 1b) are shown. Labial, liver, and renal biopsies were performed.