The indications for these drugs continue to increase
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The prevalence of renal involvement in pSS has been difficult to assess reliably, mostly due to changes in diagnostic criteria in the last 20 years and the presence of numerous studies with small number of patients or mixed cohorts of pSS and sSS ( Figure 1 According to some retrospective registries, kidneys would be affected in about 1% of pSS patients ( Symptomatic manifestations of renal dysfunction usually affect middle-aged patients, several years after the onset of pSS ( In histopathological studies, chronic tubulointerstitial nephritis was the most common finding ( Tubulointerstitial nephritis usually presents insidiously, with tubular proteinuria (which cannot be readily identified by urine testing sticks due to the absence of albumin), renal tubular acidosis (RTA) and electrolytes disturbances ( Unfortunately, the incomplete variant of dRTA may be more subtle and requires urinary acidification testing to be elicited (urinary pH persistently elevated after ammonium chloride administration) ( Hypokalemia can also cause hypokalemic muscle paralysis, with generalized muscle weakness
