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2006, Number 5

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Acta Pediatr Mex 2006; 27 (5)

Renal tubular acidosis

García de la PS

Language: Spanish
References: 22
Page: 268-278
PDF size: 323.38 Kb.


ABSTRACT

Renal tubular acidosis is a clinical syndrome characterized by hyperchloremic metabolic acidosis as a result of tubular insufficiency for renal secretion of H + ions, in the presence of a normal or near normal glomerular function. There are two main types: Proximal tubular acidosis or type II and distal tubular acidosis or type I. In proximal tubular acidosis there is a diminution in the proximal absorption of bicarbonate which results in bicarbonate wasting and low serum bicarbonate. Distal renal tubular acidosis is characterized by a decreased distal secretion of H + ions which results in metabolic acidosis. There are two variants of the distal type: one of them is associated with bicarbonate wasting in the urine (type III) and the other with hyperkalemia (type IV). All types of renal tubular acidosis may be primary or secondary to various diseases. The most common feature is growth arrest. Diagnosis is based on the presence of persistent hyperchloremic metabolic acidosis. Measurement of urinalysis, creatinine, and serum and urine electrolytes permit the differentiation of the type of renal tubular acidosis, while complementary studies indicate if a secondary condition is present. The treatment is with alkaline solutions of either bicarbonate or citrate of sodium or potassium at 3 to 5 mEq/kg/day for distal acidosis and 10 to 12 mEq/kg/day for proximal acidosis. Treatment of any other additional condition is required.


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