Distal renal tubular acidosis as the initial manifestation of systemic lupus erythematosus in an adolescent.

Distal renal tubular acidosis (dRTA) as the initial manifestation of systemic lupus erythematosus (SLE) has not been described previously. We report a 14-year-old female adolescent, first presenting with findings consistent with dRTA, whose renal biopsy demonstrated immune mesangial deposits consistent with lupus nephritis. Seven months later, she developed classic extrarenal manifestations of SLE. We recommend that adolescents with dRTA be evaluated and followed closely for the possibility of SLE.