Anti-mitochondria antibody-related tubulointerstitial nephritis accompanied by severe hypokalemic paralysis

  • Masashi Morita
  • Yoshito Yamaguchi
  • Satoshi Masuyama
  • Jun Nakamura
  • Sachio Kajimoto
  • Ryota Haga
  • Yu Yamanouchi
  • Katsuyuki NagatoyaEmail author
  • Hideaki Miwa
  • Atsushi Yamauchi
Case Report


A 47-year-old man presented with severe hypokalemic paralysis and respiratory failure. A large amount of potassium was administered along with providing intensive care, and his condition improved. Hypokalemia was attributed to increased urinary potassium excretion. A kidney biopsy was performed to make a definitive histological diagnosis. It revealed acute tubulointerstitial nephritis (TIN). After the diagnosis, prednisolone was administered, and the TIN gradually improved. From the clinical course and laboratory findings, the TIN was presumed to be an autoimmune disorder. Further specific autoantibody tests were positive for anti-mitochondrial antibody (AMA), which has been gaining increasing attention in regard to TIN. In addition, all previous cases of TIN associated with AMA have affected females. The detailed pathogenetic mechanisms are as yet unclear and require further investigation.


Hypokalemia Respiratory failure Tubulitis 



We are deeply grateful for the direction provided by Atsushi Takahashi M.D., Ph.D.; Tomoko Namba-Hamano M.D., Ph.D.; and Yoshitsugu Takabatake M.D., Ph.D. (Osaka University Hospital, Osaka, Japan).

Compliance with ethical standards

Conflict of interest

The authors have declared that no conflict of interest exists.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee at which the studies were conducted (IRB approval number 29–94) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Japanese Society of Nephrology 2019

Authors and Affiliations

  • Masashi Morita
    • 1
  • Yoshito Yamaguchi
    • 1
  • Satoshi Masuyama
    • 1
  • Jun Nakamura
    • 1
  • Sachio Kajimoto
    • 1
  • Ryota Haga
    • 1
  • Yu Yamanouchi
    • 1
  • Katsuyuki Nagatoya
    • 1
    Email author
  • Hideaki Miwa
    • 2
  • Atsushi Yamauchi
    • 1
  1. 1.Department of NephrologyOsaka Rosai HospitalSakai CityJapan
  2. 2.Department of PathologyOsaka Rosai HospitalSakaiJapan

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