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Boletín Médico del Hospital Infantil de México

2012, Number 6

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Bol Med Hosp Infant Mex 2012; 69 (6)

Renal tubular acidosis

Velásquez JL

Language: Spanish
References: 24
Page: 502-508
PDF size: 168.64 Kb.


ABSTRACT

The term renal tubular acidosis (RTA) refers to a group of clinical entities in which normal anion gap hyperchloremic metabolic acidosis occurs as a result of defective transport of the proximal tubular reabsorption of bicarbonate (proximal RTA or type 2), the distal secretion of hydrogen ions (distal RTA or type 1), or hyperkalemic RTA or type 4. These RTA types can be inherited or acquired.
Primary forms of proximal RTA are extremely rare with the majority of cases in children being found in the context of Fanconi syndrome. Primary distal RTA is the most common distal RTA found in children. Hyperkalemic RTA is found together with aldosterone deficiency or aldosterone resistance, which cause hyperkalemia, low synthesis and low levels of urinary ammonium and salts and titratable acids.
RTA may manifest in early infancy with vomiting, polyuria and polydipsia, dehydration crisis, failure to thrive and growth retardation. Children with distal RTA may present with nephrocalcinosis.
Long-term treatment with alkalizing solutions (citrate or bicarbonate with sodium and potassium) to maintain normal values of serum bicarbonate concentration induces catch-up growth, corrects the electrolyte abnormalities of the different types of RTA (hypocitraturia, hypercalciuria) and arrests progressive nephrocalcinosis in patients with distal RTA.


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