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Boletín Médico del Hospital Infantil de México

2013, Número 3

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Bol Med Hosp Infant Mex 2013; 70 (3)


Acidosis tubular renal en niños: conceptos actuales de diagnóstico y tratamiento

Muñoz-Arizpe R, Escobar L, Medeiros M

Idioma: Español
Referencias bibliográficas: 68
Paginas: 178-194
Archivo PDF: 203.61 Kb.


RESUMEN

Recientemente se ha detectado un sobre-diagnóstico de acidosis tubular renal (ATR) en niños mexicanos, posiblemente por errores de diagnóstico y desconocimiento de la fisiopatología y bioquímica molecular del padecimiento. El objetivo de la presente publicación es facilitar el conocimiento y la realización del diagnóstico acertado de la ATR, que es una condición clínica poco frecuente a escala mundial.
La ATR es la alteración del metabolismo ácido-base producida por el defecto de reabsorción del bicarbonato en los túbulos renales proximales (ATRp o proximal tipo 2) o de la excreción de hidrogeniones en la nefrona distal (ATRd o distal tipo 1). La ATR tipo 4 (hipercaliémica) obedece a alteraciones del metabolismo de la aldosterona. La ATR puede ser primaria, secundaria, adquirida o hereditaria.
Las principales alteraciones ocurren en proteínas como la anhidrasa carbónica (AC II y IV), la H+ATPasa, el intercambiador HCO3-/Cl- (AE1) y el cotransportador Na+/HCO3- (NBCe1).
El diagnóstico debe incluir la demostración de acidosis metabólica hiperclorémica con hiato aniónico sanguíneo normal (en sangre arterial o arterializada), pH sanguíneo menor a 7.35 en pacientes con acidosis metabólica descompensada (aunque puede encontrarse normal en los casos con compensación completa), alteración del hiato aniónico urinario y del gradiente urinario/sanguíneo de la pCO2. En el caso de la ATR secundaria, es importante determinar el diagnóstico de la enfermedad sistémica que la origina. Con frecuencia, los criterios diagnósticos se acompañan de diversos síntomas como anorexia, poliuria, polidipsia, detención del crecimiento, raquitismo, nefrocalcinosis, litiasis renal y sordera temprana o tardía (en la ATRd).
El tratamiento alcalino depende del tipo de la ATR: bicarbonato de sodio para la ATRp o bicarbonato o citrato de potasio para la ATRd. La administración de calcio y vitamina D depende del grado de la alteración ósea.


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